1. Strategic approach regarding investments in health under OP “Growth and Employment”  

2. EU funds financing for health
Focus on inhabitants under social and territorial exclusion risk
Concentration on four priority health areas
Strategic planning
Synergy with other sectors

3. Implementation progress
SO number SO
Available funding
Progress
Funding for which the development of implementation conditions has started
Funding for which implementation conditions have been approved
Funding for which project selection has started
Funding for which projects have been approved
Funding for which payments to FB have been made
EUR %
9.2.3.
Health network development guidelines and quality assurance system
100%
13%
9.2.4.
Common health promotion and disease prevention measures 0%
Local health promotion and disease prevention measures (1st call)
57%
Local health promotion and disease prevention measures (2nd call)
9.2.5.
Medical personnel regional accessibility
9.2.6.
Medical personnel lifelong learning
ESF
European Social Fund (total)
89%
44%
35% 1%
9.3.2.
Health care infrastructure (Major hospitals)
Health care infrastructure (Major project)
Health care infrastructure (others health care providers)
ERDF
European Regional Development Fund (total)
90%
TOTAL
93%
29%
14%
11%
Distribution of ERDF between other health care providers will be reviewed by developing national planning documents

4. State of play and policy developments Specific health guidelines development
World bank research
CoM decision on major hospital development
[ ]
Infrastructure of major hospitals [SO st and 2nd call]
Regulation [ ]
Projects [ and ]
Hospitalization plan
[ ]
Infrastructure of rest service providers
[SO rd and 4th call]
Regulation and projects
National policy planning document [Masterplan]
[ ]
Financing model
[ ]
HR lifelong learning [SO ]
Project
[ ]
HR lifelong learning [SO ] Regulation
[ ]
HR accessibility in regions
[SO ] Project
[ ]
HR availability in regions [SO ] Regulation
[ ]

5. State of play and policy developments Specific health guidelines development
Document
Project
1st draft
Final version
Date of approval
Submitted
Comments
Inception Paper -
Multiple
Health Promotion Review
 Multiple
Quality Assurance Review  
Provider Payment Review  
Research (interviews, focus groups` discussions)  
Review of the Service Delivery Model      
Review of the Benefits Package
Bottlenecks analysis  
Hospital Volume and Quality of Care in Latvia review      
mapping      
HR planning and analysis
Included in mapping
Capital investments planning     
Manitoring system manual (included in bottleneck analysis)
Policy proposals  

6. State of play and policy developments HR policies
Decrease of specialists by 21% to 6 919
Increase of GP and ambulatory nurses by 13% to 3 726
Increase of hospital nurses by 51% to 4 973
Decrease of GPs by 29% to 1 177
WB key findings regarding HR
National policy document regarding HR will be incorporated in the common policy planning document for health sector development (by )
Project applications and projects implementation plans in the frames of SO and SO will be prepared taking into account national policy planning document

7. Health infrastructure mapping WB research - key findings
Decrease of population to 1,84 m
Decrease of number of beds in acute hospitals by 28% to 5 195
Decrease of number of long-term hospital beds by 8% to 3 729
Concentration of complicated services and availability of basic services
Health care
Four stationary health care levels
Five emergency levels
Availability of ambulatory health care
Equipment planning
Infrastructure
Quality assurance system development
Health care financing management reform
Integrated health management and IS development
Gradual investments in health care infrastructure and HR
WB recommendations for the reforms

8. Health infrastructure mapping Present situation
Health care
Primary health care
1320 general practitioners
105 doctors assistants
Doctors on duty and phone consultations
204 home care institutions
14 emergency medical assistance units
Secondary ambulatory health care
11 types of primary specialists
11,6 million ambulatory visits
0,2 million operations in day hospitals
Stationary health care
3 university hospitals
7 regional hospitals
11 local hospitals
7 care hospitals
8 psihiatric hospitals
4 other monoprofile hospitals
322 thousands of hospitalisations
Emergancy medical service
190 EMS teams in 102 places
443 thousands calls
Arriving time:
in cities 15 min (89%)
in countryside 25 min (83%)

9. Health infrastructure mapping Optimization of health care network
Widening accessibility for specialized health care
Increase of scope and amount of ambulatory services
Provision of appropriate care for chronic patients
Centralization of high level specialized health care services
Geographical accessibility
Optimal resource provision according to services

10. Health infrastructure mapping Primary care
Strengthen GP capacity and resources, to ensure that patients solve their health issues at primary level
To improve team work and to promote involvement in health promotion and disease prevention
To provide an opportunity for GPs to consult with relevant specialists
It is necessary to increase state paid Primary care share in the total amount of ambulatory visits
It is necessary to develop GP network by developing multi-GP offices
Solutions for cooperation between GP and social services
Development of network of doctors on duty and revision of functions (placement, working hours etc.)
It is necessary to increase home care service provision in rural areas and to evaluate the scope of services
Optimisation of Urgent Medical Aid Stations operation

11. Health infrastructure mapping Secondary ambulatory health care
It is planned to increase the number of ambulatory services up to 12,5 m in 2025
To revise the role and functions of ambulatory health care institutions in provision of care by defining criteria for contracting
To define the set of secondary ambulatory health care services that would allow to measure result for the patient
It is necessary to evaluate the number of direct accessibility specialists and scope of services
To improve secondary ambulatory care (incl. day hospital services) in territories which are far from stationary care providers
It is necessary to clearly define services which should be provided in day hospitals, separating them from 24 hours stationary services
To improve ambulatory units in hospitals, thus improving accessibility and quality of ambulatory services in the cities

12. Health infrastructure mapping Emergency medical services
Providing the changes in stationary care institutions network, at the same time the revision of pre-hospital emergency service providers network and the evaluation of location and number of emergancy care teams will take place
It is necessary to improve arrival time for the calls to provide compliance with the control time in the regulations – in 90% of cases 15 minutes in cities and 25 minutes in rural areas

13. Health infrastructure mapping Stationary health care
Planned patients and chronic patients
Second level Urgent medical Aid Station
I level hospital
24 hour emergency help services (5 specialists)
Available diagnostics and treatment for planned and acute patients
Stabilization of health condition for transportation to higher level hospital
Distance / accessibility – up to 60 minutes
II level hospital
24 hour emergency help services (8-10 specialists )
Operates an insult unit
Distance / accessibility – up to 90 minutes
Hospital with additional specialization in oncology and cardiology
III level hospital
24 hour emergency services (10 specialists)
Secondary and tertiary care services
Distance / accessibility up to 180 minutes for tertiary care.
Hospital with specialization in traumatology / in maternal care / in rehabilitation profile
IV level hospital

14. Health infrastructure mapping Stationary health care
Source: Ministry of Health

15. Planned number of patients 2025 Number of patients per bed
Health infrastructure mapping Systemically important health care providers
Hospital
Level of hospital
Planned number of patients
Planned number of beds 2025
Number of patients per bed
Eastern Clinical University Hospital of Riga IV
80 108
2 068 39
Pauls Stradiņš Clinical University Hospital
46 723
815 57
University Children`s Hospital
17 492
355 49
Traumatology and Orthopedic Hospital
9 138
210 44
Riga Maternity Hospital
9 522
146 65
National Rehabilitation center "Vaivari"
5 181
252 21
Liepāja Regional Hospital
III
16 151
291 56
Daugavpils Regional Hospital
26 747
543
Ziemeļkurzeme Regional Hospital
13 136
247 53
Jelgava City Hospital
11 982
229 52
Vidzeme Hospital
12 952
265
Jēkabpils Regional Hospital
9 728
190 51
Rēzekne Hospital
10 277
241 43
IV level hospitals
3 846
III level hospitals
2 006 50
Total
5 852 46

16. Health infrastructure mapping Investments calculations
Available financing – EUR :
ERDF EUR
National EUR
I call EUR
II call (Stradins Hospital) EUR
III and IV call – EUR
Rationale for the calculations
88% from all the hospital beds are already concentrated in high intensity stationary health care institutions
Lower intensity hospitals demand lower technology provision and smaller area of premises is needed to provide relevant services.
Ambulatory service delivery should be developed in order to make basic services more accessible (especially primary health care)
Calculations are similar to the approach used in EU funds period when local and care hospitals and ambulatory health care institutions (incl. primary care centres) received 15% (in comparison to the previous period, presently the support is needed for a considerably smaller number of lower level institutions).

17. Health infrastructure mapping Major medical devices
Nr.
Medical equippment
Unit costs (may vary), euEUR
I Medical equippment, with unit costs above EUR 1.
USG
Up to 2.
Endoscopic Unit
Up to 3.
X-Ray
Up to 4.
Mammography Unit
Up to 5.
Gamma Camera
Up to 6. CT
Up to 7.
Angiography
Up to 1  8.
MRI - Magnetic Resonance Imaging
Up to 1  9.
Linear Accelerator
Up to
II Medical equippment, with unit costs from 20 000 EUR to EUR
10.
Incubator, Infant (intensive care)
Up to
11.
Surgical table
Up to
12.
Anesthesy Unit
Up to
13.
Lithotripter
Up to
14.
Laparoscopy Unit
Up to

18. Health infrastructure mapping Premises development needs
Necessary area calculated based on beds planning data
Necessary area compared with existing area thus calculating necessity for new area
Necessary area (reduced by new area) compared with developed area in last 10 years thus calculating renovation necessity
Necessity for development of ambulatory care calculated based on present ambulatory care unit areas
Based on identified area and average construction costs, necessary investments are calculated for the development of premises and adding 15% for furniture, IT and small medical devices

19. Health infrastructure mapping Investments calculations (corrections)
Allocation corrected according to the calculated needs
IV level university hospitals up to 25 000 000
IV level mono-profile hospitals up to 2 500 000 EUR
III level hospitals up to 15 000 000 EUR
Allocation corrected according to the maximum project amount according to the relevant hospital level
Allocation corrected according to the distance from institution to Riga
Allocation is corrected proportionally according to the available financing

20. State budget activities Improvements in 2017
Sector
Additional services
Ambulatory care
Ambulatory examinations and treatment accessibility
patients
Number of diagnostic examinations in primary health care (GP referrals)
examinations
Ambulatory rehabilitation and physical medicine services
patients
Oncology patient care
Number of diagnostic examinations in secondary ambulatory care in oncology (specialist referrals)
patients
Hospital level oncology patient treatment
+10% (+3445 patients)
Medicine accessibility per unique patients in oncology
+20% (+4494 patients)
Reimbursed medicine
Patient provision with reimbursed medicine for existing diagnosis and medicines
unique patients
Improved service accessibility
Specialists
patients
Day hospitals
patients
Endoprosthetics
patients

21. Thank you!
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