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

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

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

1. Health in LaTVIA

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 Around OECD average Diabetes: avoidable hospital admissions Around OECD average Prescribing antibiotics Well below OECD average AMI: 30 days mortality Highest in OECD Stroke: 30 days mortality Highest in OECD ⃰

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

Poorer Latvians report higher unmet need Unmet need for medical examination (too expensive, too far to travel, or waiting time), by income level, 2013 On average 13.8% of Latvians report unmet care needs, compared 3% across OECD 23 countries 1 in 4 of low income population forewent care in Latvia Note: OECD EU countries. Source: EU-SILC 2013.

Cost: a main driver of unmet need Self-reported unmet needs for medical examination: too expensive Note: EU countries. Source: EU-SILC 2013.

Poor health care resources may damage performance Low public investment in health: 3.4% of GDP High out-of-pocket spending: 38% of THE Same practicing doctors as OECD 3.1 per 1 000 population Nearly half the nurses as OECD: 4.9 per 1 000 population

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

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, http://dx.doi.org/10.1787/health-data-en; WHO Global Health Expenditure Database.

2. TACKLING KEY CHALLENGES…

Improving access to care 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

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

Certain efficiency gains: Improve efficiency 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

More resources may be needed To see health outcomes closer to the OECD average To tackle problems with access and quality For sustainable long-term performance 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 CONCLUDE…

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

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