The Ministry of Health (MoH) proposes to move to a three-tier hospital model by 2029 instead of the current five levels, to introduce a quality-indicator-based funding system, and to give healthcare institutions greater flexibility in the use of funds, according to the MoH report “On the Hospital Network,” which has been released for public consultation.
As MoH Communications Head Oskars Šneiders told LETA, the report sets out principles for organizing the hospital network rather than changes to the operations of individual institutions. “It is important to note that no decisions have been taken at this stage on reviewing the profiles or reorganizing specific hospitals,” the ministry stresses.
The MoH proposes a three-level hospital model: multi-profile hospitals, regional hospitals, and local hospitals.
Specialized healthcare institutions would form a separate network. Regional hospitals would provide emergency care in internal medicine and surgery, while local hospitals would provide basic therapy, care for chronic patients, and palliative care.
Hospital levels and the range of inpatient services will be determined by hospital capacity,
available medical staff, infrastructure, and the complexity of services provided, the MoH explains.
At the same time, emergency medical care is to be ensured in all hospitals regardless of level. Each hospital will have physicians, support staff, and 24/7 laboratory and diagnostic services available to residents.
To reduce overload in emergency departments, from 2025 the MoH plans to pilot “urgent medical care units” in smaller hospitals with low patient flow.
The MoH also plans to introduce uniform patient observation criteria to prevent unjustified hospitalizations. Currently, on average 80% of observed patients do not require admission after short-term treatment. The development of observation services will help reduce unnecessary hospitalizations and improve care efficiency.
The ministry emphasizes that special attention will be paid to hospitals near the external border
to ensure continuity of access to emergency medical care. Cooperation with the Emergency Medical Service will be strengthened, the deployment of crews analyzed, and network expansion planned.
Given limited state budget funding, the financing model must be reviewed to give institutions greater flexibility in using funds while promoting more efficient treatment of patients.
Thus, by 2029, hospital funding will also take into account the quality of services provided, in order to strengthen more efficient providers rather than maintain all hospitals equally regardless of results, the report states.
The funding model should ensure greater managerial flexibility
while incentivizing services outside inpatient care and promoting recovery at lower-level hospitals. Funding principles should not restrict work organization regarding staff allocation to specific departments or on-call duties within a single hospital.
The MoH also proposes assessing a “bulk financing” (global budget) pilot project in one medium-sized Latvian hospital. As in Scandinavia, the hospital would receive a fixed annual budget rather than precise payment for each patient. The hospital would be responsible for delivering a set volume and quality of services, and the pilot results would be compared with a similar hospital continuing under the current funding model.
The goal of the pilot is to reduce low-value hospitalizations and tests and shift remuneration toward outcomes, not merely the volume of services delivered.
The ministry notes the reform is necessary because
Latvia still lacks medical staff, and hospitals’ ability to provide 24/7 on-call coverage varies significantly.
A hospitalization-procedure pilot implemented last year showed that some hospitals do not provide emergency care in adequate amounts due to staffing shortages, so the existing arrangements need review. Therefore, the report includes a gradual package of measures in line with the State Audit Office’s recommendations on organizing inpatient healthcare, the MoH says.
Demographic challenges are similar in other EU countries; hospital network reviews are currently underway in Estonia, Lithuania, Germany, Ireland, Austria, Slovakia, and elsewhere, the ministry notes.
The report is open for public consultation until 7 November. An in-person discussion at the ministry is scheduled for 13 November from 11:00 to 14:00. Applications to participate and suggestions for the meeting should be sent by 7 November to [email protected].
Read also: The end of “tasty” e-cigarettes: Court confirms flavour ban