OECD REVIEWS OF HEALTH SYSTEMS: LATVIA Francesca Colombo Head of OECD Health Division Riga, 20 September 2016

Aging, shrinking population High prevalence of risk factors Quality and efficiency initiatives underway but room for improvemen Under-funded system compared to OECD Health in Latvia today 2

Improve access to care Build a data-drive health system Strengthen preventive care Rise efficiency, strategic contracting 3 Next steps:

1. HEALTH IN LATVIA 4

5 Poor health outcomes Source: OECD Health at a Glance Europe 2016, forthcoming

Quality of care: room for improvement Latvia COPD and asthma: avoidable hospital admissions Diabetes: avoidable hospital admissions Prescribing antibiotics AMI: 30 days mortality Stroke: 30 days mortality Around OECD average Well below OECD average Highest in OECD 6

Waiting times are often long Comprehensive service coverage Access to care: obstacles remain High out-of-pocket payments High unmet need 7

8 Poorer Latvians report higher unmet need Unmet need for medical examination (too expensive, too far to travel, or waiting time), by income level, 2013 Note: OECD EU countries. Source: EU-SILC in 4 of low income population forewent care in Latvia On average 13.8% of Latvians report unmet care needs, compared 3% across OECD 23 countries

Cost: a main driver of unmet need Note: EU countries. Source: EU-SILC Self-reported unmet needs for medical examination: too expensive

Poor health care resources may damage performance Same practicing doctors as OECD3.1 per population Nearly half the nurses as OECD:4.9 per population 10 Low public investment in health: 3.4% of GDP High out-of-pocket spending: 38% of THE

Per capita GDP and health spending (in real terms) in Latvia, 2005 – 2015 (2005=100) 11 Health spending returning slowly to pre-crisis level Source: OECD Health Data; OECD National Accounts Database

12 But health expenditure remains low Health expenditure as a share of GDP, 2015 (or nearest year) Note: Excluding investments unless otherwise stated. Source: OECD Health Statistics 2015, WHO Global Health Expenditure Database.

2. TACKLING KEY CHALLENGES… 13

 Commendable efforts to improve access:  Opening rural practices  More nurses in primary care  Free hotel-accommodation for some groups  Physician assistant or “feldsher” role:  Next steps  Cost-sharing exemptions for vulnerable patients  Assess if “quota” system is fit for purpose  Focus on prevention 14 Improving access to care

Improve quality and data use  Quality initiatives are underway:  P4P in primary care  Incentives for early cancer detection  Coordination in emergency and primary care  Electronic health record launch imminent  Next steps:  From minimum standards to quality improvement  Build a data-driven system  Open data publication and benchmarking 15

16  Certain efficiency gains:  Reduction in hospital use, shift to outpatient  Recent introduction of DRG system  Centralised emergency triage system  Next steps:  More strategic contracting  Better targeting of waste Improve efficiency

More resources may be needed 17  Initial steps:  A spending review  A comprehensive five or ten-year plan  A workforce plan to assess and project need  Developing long-term care To see health outcomes closer to the OECD average To tackle problems with access and quality For sustainable long-term performance

TO CONCLUDE… 18

19 Key policy recommendations Focus on improving quality Drive efficiency gains Consider carefully increasing health spending Improve access to care

Contact: Read more about our work Follow us on Twitter: Website: Newsletter: Thank you 20