Lithuania

Background

Since its independence in 1990, Lithuania has undergone two waves of healthcare reforms between 1991 and 1997. The first wave came right after independence, and by 1991 the Law on Social Insurance was approved, starting nationwide development of statutory social insurance as well as the decentralisation of public healthcare administration. However, other reforms in these early years were slow and without major impact.

This changed with the second wave of reform, which occurred between 1995 and 1997, during which time the Health Insurance Law was passed. Two types of health insurance were created at this time: compulsory and additional voluntary health insurance. Also during this reform period people were forced to register with a primary healthcare provider of their choice, increasing registration to 90% within a year. Other reforms made general practitioners gatekeepers of the system, and introduced hospital choice, contract-based financing of healthcare institutions and improvements in training and retraining for medical staff.

This second wave created the base for today’s healthcare system and paved a path for future reforms. The structure for healthcare financing established during the second reform period now consists of four basic funding sources. These are general taxation, contributions to the statutory health insurance system determined annually by parliament, contribution to voluntary insurance (which remains a very small portion) and direct cash payments to providers.

Recent years

Reforms in recent years have focused on lifestyle changes. Increased funding has allowed the creation of mental health institutions in most municipalities, as well as greater public education concerning tobacco use and alcohol consumption. It is important to note that Lithuania’s success and consistency in health reforms can be attributed to a high consensus among the different political parties, so that measures implemented under one administration continue to be improved upon by the next party in power.

Current situation

Future reforms concentrate on developing outpatient services, shifting the focus from specialised to primary care, optimising inpatient services and building up long-term support systems for the elderly. If healthcare reforms continue to receive adequate political support, as before, future reforms can target issues like mental health, tobacco use, alcohol consumption, out-of-pocket payments and an ageing population.

In an effort to reinforce the State Social Insurance Fund in the midst of the current economic crisis, the government has proposed to stop paying workers for the first three days of their sick leave. With the average duration of sick leave in Lithuania consisting of 6 days, by not paying for the first 3 days of leave the government is cutting sick pay by half. As a result it is expected to generate significant savings for the State Social Insurance Fund.

Lithuania statistics