1. Response to the crisis - Lithuanian way

2. Dynamics of Compulsory Health Insurance Fund Budget and Gross Domestic Product (GDP) from 1998 to 2010

3. Reform trends in 2009-2011 New Pharmaceutical Policy Reorganisation of the hospital network Point (that is an coefficient used for the payment of health care services) reduction Reform of budgetary health institutions Maintaining the same level of funding for public health

4. A Response Plan was developed to improve pharmaceutical accessibility and to reduce prices The Plan was approved by the Minister of Health in June 2009 All measures of the Plan will be implemented in December 2011 28 measures of the Plan involve all players of the pharmaceutical market

5. Number of prescriptions for reimbursable medicines and medical devices (MD) and dynamics of average prescription price

6. Expenditure of NHIF budget to reimburse medicines and medical devices (mln LTL)

7. Average prescription price and average mark-up on prescription (LTL)

8. Conclusions. Pricing and cost reduction From 2009 to 2011 first half the average prescription price has decreased from 61 to 53 LTL (about13%) From 2009 to 2011 first half the average co-payment for prescription has decreased from 18,8 to 12,97 LTL (31 %) During 2010-2011 CHIF budget will save about 65 mln LTL for reimbursable medicines and medical devices During 2010-2011 patients will save about 60 mln LTL from co-payments for reimbursable medicines and medical devices Cost reduction in 2011 has started to compensate for new innovative drugs (all from 2007, pending the Waiting list)

9. Reorganisation of hospitals 2010-2011 Goals  Improving the quality of treatment and patient security  Strengthening the primary care and outpatient levels by transposing funds and professionals from the in- patient level  Efficient use of existing resources Trends  Restructuring of health care services (RRR reform)  Optimization of the network of health care institutions

10. Regional and district hospitals Regional hospitals must meet two basic criteria: more than 1100 major surgeries and more than 300 childbirths District hospitals  With surgery and obstetrics (if tending to over 300 childbirths)  With surgery (if performing over 660 major surgeries)  Without surgery and obstetrics

11. Optimization of the hospital network Principles:  Integrating mono-profile hospitals into multi-profile ones  Merge geographically proximate institutions Network:  2 University research and treatment centres  8 National level hospitals  9 Regional level hospitals  38 District level hospitals (including 12 with surgery and obstetrics unit and 10 with surgery unit)

12. Optimization of the hospital network and services (ongoing) The number of health care institutions (legal entities) decreased by 19 More than 70 different services (surgery, obstetrics, neurology, psychiatry, cardiology, etc.) are no longer bought from different hospitals Decreasing numbers of hospital beds in 2010 comparing to 2009 (including nursing, rehabilitation and long term care services)  University level hospitals – 0,0  (0)  National level hospitals – 0,8  (-71)  Regional level hospitals – 2,2  (-49)  District level hospitals – 4,7  (-257)

13. Number (thousands) of actually provided inpatient, outpatient and short term health care services in 2008– 2010 Source: Data by the information system SVEIDRA Number of provided services (243,3 thousands) in 2010 increased by 2,7% comparing to 2009 +3,2% +5,9% -2,8% 8.871,2 9.114,4 Specialized services in total 8.837,6

14. Reorganization of budgetary institutions subordinate to the Ministry of Health in 2009-2012 The number of 19 budgetary institutions subordinate to the Ministry of Health decreased by 7 During the reorganization 470 staff positions were disestablished

15. The value of the point used for payment of health care services from CHIF budget variation in 2005-2011  The value of the point for primary health care services – increased by 0,05 LTL

16. Maintaining the same level of funding for public health Development of municipal public health offices Number of offices: 2008 – 27; 2009 – 31; 2010 – 32; 2011 – 33 Preventive programmes financed from the CHIF‘s budget Number of programmes: 2008 – 5; 2009 – 6; 2010 – 6; 2011 – 6 Bugdet : 2008 – 25,9 mln LTL; 2009 – 29,2 mln LTL; 2010 – 31,7 mln LTL; 2011 – 33,6 mln LTL; plan 2012 – 38,3 mln LTL

17. Look into the future Reorganization of the hospital network, implementation of all 28 measures of the (Pharmaceutical) Plan and the reform of the budgetary health institutions should be finished by the end of 2011 The year of 2012 is intended for the analysis and the development of new plans considering achieved results and the country’s economic situation (threat of economic slowdown)