Healthcare ranks at the top of the priority list for every Latvian resident. Yet, the sector is also riddled with “tough questions” more than perhaps any other. What are the real benefits of the pharmaceutical reform? How long will patients continue to endure lengthy queues to see specialists? How good is the quality of care in small regional hospitals? How can we improve demography? These and other questions were discussed by BNN in an interview with Health Minister Hosams Abu Meri.
It has been nearly half a year since the implementation of the pharmaceutical reform. What are your conclusions—has it justified itself? What specific benefits or savings has it brought to the population?
At least 75% of Latvian residents are now paying about 13 euros less for medication due to the reform. If a person uses medications costing less than five euros alongside more expensive ones, the savings are moderate. But for those who use only the more expensive drugs—starting at 10 euros or more—the reduction should be quite significant.
On the other hand, for the patient group using drugs costing up to 5 euros, there is an increase of up to 70 cents, depending on the medication. It’s important to note that chronic patients pay the 75-cent dispensing fee only once every three months.
We knew this reform—left untouched for 20 years—would not be easy. We also understood that the system needs continuous improvement. But we also faced significant opposition to the reform, including not just active resistance, but also withholding of necessary information. For example, we still don’t have exact data on how many paper prescriptions are issued in Latvia over a given period.
Now that we receive reports every three months, we see that the total number of prescriptions has increased. About 30,000 people in Latvia have more than five prescriptions a month. That’s why we’re now evaluating whether to introduce a cap on prescription dispensing fees.
So, if a person has ten prescriptions, for example, would pharmacies not be allowed to charge 7.50 euros, but a fixed maximum fee instead?
Yes, we are considering such an approach. I can’t say yet whether this ceiling will be set at the cost equivalent of processing four or five prescriptions, or if it will be a fixed sum as a limit for the service – that still needs to be determined.
What’s important is that now we have better cooperation with the industry, which is finally providing data – both pharmacies and wholesalers are attending meetings and understand that our goal is to reduce costs for residents on medicines that cost 5 euros or less. For those medications that cost fifty, a hundred, two hundred or more euros, the 0.75 euros pharmacist service fee has virtually no impact. That’s why we are currently working on a formula to balance the markup and the service fee as optimally as possible for medicines in the under-5 euros price category. Overall, I’m satisfied with the reform because the results are good, and now we have a better understanding of where the system needs further improvements.
Before the reform, there were concerns it would cause rural pharmacies to go bankrupt. How has that played out now, after nearly six months?
They are all still operating. That’s precisely why we introduced the dispensing fee. Initially, pharmacies wanted to charge three euros, but we agreed on 1.50 euros, with a higher 2.50 euro fee for pharmacies in rural areas. There’s no data showing that any rural pharmacy closed because of the reform. A few have closed, but that was planned before the reform. In fact, some new ones have opened. The fears spread before the reform—claiming rural pharmacies would disappear—have not materialized.
There were also objections that pharmacies have to purchase expensive drugs upfront, risking that they won’t be bought by patients.
We are working on improving this situation.
How is the expansion of the state-reimbursed medication list going? Are modern, innovative drugs for rare diseases included? What happens to patients who need medications not included in the reimbursed list?
Compared to our neighbors and Europe, our budget is one of the smallest. When I first took office, I said Latvia needs an extra half a billion euros in the healthcare budget to match Lithuania’s level. To match Estonia, we’d need a billion. That includes reimbursed medications.
The National Health Service estimates that we need an additional 150 million euros just for medications.
But it’s not entirely accurate to say our neighbors have everything. In fact, we are ahead of Lithuania in terms of access to innovative medicines—we’re somewhere between Estonia and Lithuania. In 2024, we even surpassed Estonia temporarily in this area, but they are now investing more.
This year, I managed to secure an extra 26 million euros for the reimbursed medicines list. We added 11 new diagnoses and several new drugs, especially for oncology and rare diseases. Over two years, we’ve increased oncology reimbursements by 32%.
We’ve also introduced new, state-funded services for diabetes patients. The budget for reimbursed medicines has grown from 219 million to 308 million euros. My top priority as minister is medication—both in terms of cost and access. And we know where each euro goes.
Still, last year, extra funding was allocated to reduce waiting times, including for outpatient and inpatient services. Yet queues remain. Why?
We need to improve digital systems to track effectiveness and increase funding. Reducing queues requires system capacity and medical staff. There’s a global shortage of healthcare professionals. Even if I allocate more funds for services—who’s going to provide them?
What’s the solution?
There’s no miracle pill. One solution is digitalization. From the 1st of January, all vaccination data must be entered in the digital platform. We now know who got which vaccine, where, and by whom.
We also changed the rules to allow transferring unused vaccines between institutions. We’ll see the impact this autumn.
This fall, you’ll begin testing the unified digital appointment system. How will that help?
It will show where appointments are available fastest. Also, patients will no longer be able to book appointments with the same referral at several institutions—then only show up to one.
Currently, about 20% of patients don’t show up for their appointments. With digital booking, we can reduce this no-show rate.
What about care quality outside of Rīga—especially in small hospitals?
I’m pleased that we now have methodological leadership institutions for psychiatry, oncology, cardiology, pediatrics, radiology, rehabilitation, and family medicine. One for obstetrics is coming soon.
We’ve allocated additional funding for emergency departments in hospitals, and by June the National Health Service and Emergency Medical Service will report on the system’s effectiveness.
We won’t have every specialist in every small hospital. I myself, as a gastroenterologist, won’t drive to Balvi every day if there are too few patients. But if local doctors are doing quality work and have enough patients, that’s fine. Otherwise, it may be better to refer patients to regional hospitals with more experience and better access.
What about expensive equipment that stands idle due to lack of staff?
We need to assess whether we really need CT and MRI machines in every corner of Latvia. We know which facilities have overused and underused machines. This will also inform our new hospital funding model.
Tell us more about the new digital appointment system.
Patients will be able to see where they can get appointments fastest and book them directly. They won’t be allowed to book multiple appointments with one referral.
Testing begins at year-end, full launch is planned for next year.
There have been public complaints about poor experiences in healthcare facilities. Is the Health Inspectorate actually checking these, or just reviewing paperwork?
There have been changes in the Health Inspectorate beyond just leadership. I’ve asked them to reduce bureaucracy and improve communication with patients.
But they lack capacity and have a backlog of documents. That’s why we’re involving the Medical Association and methodological institutes in reviewing medical complaints.
Many complaints—about 48%—relate to poor communication or unclear explanations, not necessarily medical errors.
From the 1st of July, all healthcare institutions will need a patient rights protection plan and a dedicated staff member. Institutions will first be expected to resolve complaints internally.
In future, this process will also be digitalized, with AI potentially sorting complaints by topic.
What about excessive bureaucracy in healthcare? Are doctors still drowning in paperwork?
We are reducing it step by step. But doctors must be willing to use new digital systems, even if they’re not perfect yet. From the 1st of April, 90% of hospital discharge summaries must be uploaded to the e-health system.
Overall, our digitalization is quite advanced, though systems don’t always communicate with one another. That’s being addressed.
How is cancer screening being improved under the 2025–2027 Oncology Plan?
Last year, we increased screening participation by 10% by having GPs call patients.
In Slovenia, 80% respond to mailed invitations. We send letters too, but people don’t show up.
We want to start sending reminders by text and include screenings in mandatory health checks.
In Slovenia, preventive checks begin at age 30 and are repeated every 3–5 years. In Japan, they start in school and are funded by the Ministry of Education.
Cardiovascular diseases remain a major cause of illness and death. What’s being done?
We’re working on a national cardiovascular care plan.
We need to promote healthy lifestyles, physical activity, and proper nutrition. EU funding for public awareness has decreased, so we must now plan national budget allocations.
We’ve also developed an obesity reduction plan.
Finally, what can be done to improve Latvia’s demographic situation? Is there a real plan?
Demography has been declared a priority by the government and the President.
But it’s not just about benefits. Many well-off people don’t want kids—they want freedom and travel. When they change their mind around 40, they begin to worry about health and parenting capability.
People need to feel confident that their health—and that of their children—will be protected. Investing in public health, access to care, fulfilling the Oncology, Maternal and Child, and Cardiology Plans—these will all contribute to better demographics.
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