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

2. 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

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

4. 1. HEALTH IN LATVIA 4

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

6. 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

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

8. 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 2013. 1 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

9. Cost: a main driver of unmet need Note: EU countries. Source: EU-SILC 2013. 9 Self-reported unmet needs for medical examination: too expensive

10. Poor health care resources may damage performance Same practicing doctors as OECD3.1 per 1 000 population Nearly half the nurses as OECD:4.9 per 1 000 population 10 Low public investment in health: 3.4% of GDP High out-of-pocket spending: 38% of THE

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

13. 2. TACKLING KEY CHALLENGES… 13

14.  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

15. 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. 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

17. 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

18. TO CONCLUDE… 18

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

20. Contact: Francesca.Colombo@oecd.orgFrancesca.Colombo@oecd.org Read more about our work Follow us on Twitter: @OECD_Social@OECD_Social Website: www.oecd.org/healthwww.oecd.org/health Newsletter: http://www.oecd.org/health/updatehttp://www.oecd.org/health/update Thank you 20