Lithuanians who have studied abroad face almost insurmountable obstacles when trying to continue their training at home, while young doctors who want to work in their own country are excluded from the health insurance system.
Povilas Ancevičius studied at the University of Freiburg in Germany. It is one of the most prestigious German universities, but when he tried to continue his residency in Lithuania, the young doctor was rejected, and not because of his clinical experience, but because the curriculum was slightly different. In Germany, the dental study program does not include a math course, which is taken into account when entering a residency in Lithuania. The lack of a math grade denied him residency. Ancevičius has applied for residency several times, but has never been admitted. He said it sounds absurd, but it is precisely for this reason that several of his colleagues have chosen not to return home.
The Lithuanian government has publicly pledged to lure young specialists home, but it seems that the conditions for entering residency have not been designed with this in mind. Jurgita Sejonienė, a member of the Seimas Health Commission, who herself has a medical degree, said she was shocked when Ancevičius outlined the problem to her. She said that at the same time that doctors and nurses from third countries are being accredited in Lithuania, obstacles are being created for the very people who want to return, and this is happening at a time when the government is talking about repatriating young Lithuanians home. Sejonienė promised to raise the issue both at the Ministry of Health and at home.
Residency is not the only obstacle in Ancevičius’ path. Even without entering residency, he decided to stay in Lithuania and open his own clinic in Šiauliai. In doing so, he faced a problem that affects young doctors all over Lithuania. The Lithuanian State Health Insurance Fund (VLK) controls which clinics can provide state-funded services to patients.
Without a contract with the VLK, clinics cannot provide state-funded dental services for pensioners,
which covers 670 euros every three years. The VLK concludes contracts based on demand, and if it decides that the existing providers are sufficient, no new contracts are concluded.
Ancevičius invested around 560,000 euros in the establishment of the clinic, using support from the employment agency, funds offered by the state bank, municipal support and funds from the European Union structural funds. Despite this, the VLK does not conclude a contract with his clinic.
A similar situation has come to the attention of dentist Goda Sutkutė, who studied at the Lithuanian University of Medical Sciences and is planning to open a clinic in Vilnius this summer. She has been working in her field for seven years and sees about ten patients a month in her mother’s practice, whose treatment is paid for by the state. Sutkutė said that for 670 euros, a full set of dentures can be made, which larger clinics, which also have higher administrative costs, cannot offer. There, a full set of dentures costs around 2,000 euros. She said that it is a strange situation in which the patient suffers the most: “They end up significantly overpaying for treatments that are covered by state funds.” Both doctors pointed out that the system is currently designed to protect large clinics from competition, regardless of the fact that new service providers could provide patients with better quality and lower costs. Sutkutė noted that there are ways to circumvent the system, and that there are agreements between clinics to redirect patients who receive state-funded services, but she questioned why such unofficial systems are needed. She said that
the amount of money does not change, the number of pensioners does not change, and it is strange that the funds are allocated only to a closed circle.
Ancevičius compared the situation to Germany, where cities have restrictions on new clinics from signing contracts for state-funded services, but these are only in force to promote the provision of services in regions where there is a shortage. In Lithuania, new contracts cannot be signed either in large cities or in smaller regional centers.
The VLK denied that the system restricts competition, and its representative Vita Lyskoitienė said that there is no official ban on signing new contracts, and they are signed when the assessment shows that demand is greater than the existing supply. Asked whether the system could deny pensioners access to better equipment than is available in the new clinics, and whether this is not a barrier to receiving the best possible care at a lower price, Lyskoitienė did not directly answer the argument about quality. She only pointed out that there are currently 1,150 contracts for dentures in force in the country, suggesting that patients have a fairly wide choice.
Meanwhile, Sejonienė said that she does not consider the current arrangement acceptable, and it does not seem right that public money is distributed in this way: “It is absurd if a person cannot choose which clinic to be treated at.” She added that it reflects a broader trend – everyone sees that private medicine is being ignored, with the exception of a few very large providers.
Read the full article in English here: https://www.lrt.lt/en/news-in-english/19/2926156/lithuania-s-health-system-is-locking-out-its-own-doctors
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