Ilona Bērziņa, BNN
The phrase «rescue of drowners is in the hands of drowners» in Latvia has, unfortunately, become a sad reality in nearly all sectors of life. Countless residents, businesses and even industrial sectors are forced to survive. It is sad that this kind of approach to saving drowners applies to different manufacturing sectors of the national economy, but the fact that it is also a reality for sectors like healthcare and education is a tragedy.
Last week Latvia’s President Egils Levits presented a truly genius revelation: «An organised healthcare system will help strengthen people’s trust in the state». I believe any Latvian resident would be prepared to sign under this phrase. Even the proposals from Latvia’s new Minister of Health Līga Meņģelsone presented during the meeting are reasonable and welcome.
But I do not remember a single minister who wasn’t full of commitment and promised the sector the sun from the sky when they first started working. Throughout the years one thing or another kept failing. This is why I wish Meņģelsone luck from the bottom of my heart, but I remain somewhat sceptical. More so than usual, considering what Minister of Finance Arvils Ašeradens said – that this year funding for healthcare has reached its border.
In the current situation healthcare is, mildly putting it, poor. Instead of the sector’s requested EUR 200 million the state has allocated EUR 85 million (the total funding planned from the state budget project is EUR 1.6 billion). Hospitals, meanwhile, warn that insufficient funding has caused things to deteriorate in the healthcare sector, adding that things will get even worse in the future. Pharmacies suffer from shortage of medicines. People have to wait for months to receive state-funded medical services (years in certain cases). Regions suffer from shortage of general practitioners.
The list goes on, but what’s the point of talking about symptoms if the cause remains untreated?
In an attempt to untie this Gordian knot, we have to ask the usual question: who is to blame – money or lack of political will or inability to organise the system once and for all? The general consensus is that the reason why the system is to blame is because of the previous head of the government Kariņš and the new, current head of the government Kariņš.
Even before the protest organised by medical workers on the 7th of November 2019 Krišjānis Kariņš told TV Panorāmā: «The system needs to be made more efficient, so that doctors and patients understand where the money goes». In 2021 the PM told Saeima deputies that the pandemic should be used to increase funding and sort out the healthcare system. Now the new PM Kariņš once again outlines serious problems with state-paid medical system. But this time the problem lies in the inefficient hospital network, which is why it needs to be reorganised.
There can be no objections to this, at first glance. It would be great if people didn’t have to wait for hours and if the expensive medical equipment was used adequately for state-paid examinations and all cancer patients, not just 30% (SIFFA and IQVIA research centre data). It would be great if innovative, next generation medicine was also available.
But the question for how long the government and Ministry of Health will continue only talking about reorganising the system without any actual action remains open.
If it is necessary to perform an audit of funding provided to the healthcare sector, let’s do this!
But it would be better if responsible officials to notice the inflation, the real costs for medicine, catering and bed per patient, instead of continuing to live in a fantasy world in which all this costs pennies.
Otherwise we will end up in a situation when hospitals are forced to charge patients extra to acquire the missing funding, which would catastrophically impact patients’ health.
There is this curious document titled Guidelines for public health 2021-2027, which states: «The state of health of Latvian residents, when compared with the average level in the EU, remains very poor»; «[…] the number of years spent living healthily remains the lowest in the EU – in 2018 it was 53.7 years for women and 51 years for men». «Poor public health indexes can be explained with long periods of insufficient state budget funding towards healthcare, which remains one of the lowest in the EU. This is why part of healthcare costs are covered from patient fees, which are some of the highest in the EU».
OECD mentioned in its report for 2019 – although healthcare costs in Latvia are up, they remain some of the lowest in the European Union. Now, the main problem – chronically insufficient funding – was identified a long time ago. But where is the solution?
Reduction of the number of hospitals (doesn’t matter which reform is responsible) is unlikely to be a magic wand that will solve all existing problems. On top of that, reforms of this kind have always been very sensitive socially. This includes the protest in Bauska in 2009, when protests were organised to object to the liquidation of a local hospital. Ideas about treating stroke patients by sticking a bandage on their leg never work.
Neither Kariņš nor Meģelsone are the first the attempt to organise the healthcare system. Nearly all ministers since the first protests of 1993 have promised as much. Various protests from medical workers over wages have continued over the years,
whereas governments have mostly focused on new and innovative pay models this whole time.
The last time was during Krišjāņš Kariņš’s government. However, the model approved for adoption in 2023 is unlikely to go. This is because, according to Minister of Health Līga Meņģelsone, «launching an incomplete model would be wrong». The idea is agreeable, only if people are forced to wait for a new model to come, it should come as no surprise if medical workers start leaving the country entirely.
The old Kariņš previously said that there are not enough taxpayers in Latvia to maintain the country’s healthcare system. However, without supporting this system adequately, there may be even fever taxpayers. The phrase about the drowners doesn’t really work – inflation, high energy resource prices, growing bank interest rates for mortgage loans, food price surge and other factors that make life more expensive will soon eat away most of Latvian residents’ reserves.
I would like to hope we will soon see an economically-justified a clear plan that would help reanimate the healthcare system. What were the criteria used by the National Health Service to calculate the tariffs for services provided by hospitals?
What will we do to ensure attraction of new healthcare specialists and their retaining? How are we supposed to ensure a full basket of medical services? Will we use innovative medicines or will we continue using citramon, active coal and mustard bandages?
Also read: Latvian Ministry of Health to focus on cancer treatment, child healthcare and higher wages