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

2. 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

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

4. 1. Health in LaTVIA

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
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 ⃰

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

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
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.

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

10. 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 population
Nearly half the nurses as OECD: 4.9 per population

11. Health spending returning slowly to pre-crisis level
Per capita GDP and health spending (in real terms) in Latvia, 2005 – (2005=100)
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.

13. 2. TACKLING KEY CHALLENGES…

14. 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

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

16. 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

17. 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

18. TO CONCLUDE…

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

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