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Latvia Health System Review Health Systems in Transition Vol. 10 No. 2 2008 Latvia Health system review Ellie Tragakes Girts Brigis • Jautrite Karaskevica Aiga Rurane • Artis Stuburs Evita Zusmane Editors: Olga Avdeeva • Marco Schäfer Health Systems in Transition Written by Ellie Tragakes, American College of Greece with Girts Brigis, Riga Stradins University Jautrite Karaskevica, Health Statistics and Medical Technologies State Agency Aiga Rurane, WHO Country Office Latvia Artis Stuburs, Gulbene Region Municipality Evita Zusmane, State Compulsory Health Insurance Agency Edited by Olga Avdeeva, European Observatory on Health Systems and Policies Marco Schäfer, Technische Universität Berlin Latvia: Health System Review 2008 The European Observatory on Health Systems and Policies is a partnership between the World Health Organization Regional Office for Europe, the Governments of Belgium, Finland, Greece, Norway, Slovenia, Spain and Sweden, the Veneto Region of Italy, the European Investment Bank, the Open Society Institute, the World Bank, the London School of Economics and Political Science, and the London School of Hygiene & Tropical Medicine. Keywords: DELIVERY OF HEALTH CARE EVALUATION STUDIES FINANCING, HEALTH HEALTH CARE REFORM HEALTH SYSTEM PLANS – organization and administration LATVIA © World Health Organization 2008, on behalf of the European Observatory on Health Systems and Policies All rights reserved. The European Observatory on Health Systems and Policies welcomes requests for permission to reproduce or translate its publications, in part or in full. Address requests about publications to: Publications WHO Regional Office for Europe Scherfigsvej 8 DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office web site (http://www.euro.who.int/pubrequest). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the European Observatory on Health Systems and Policies concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the European Observatory on Health Systems and Policies in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the European Observatory on Health Systems and Policies to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the European Observatory on Health Systems and Policies be liable for damages arising from its use. The views expressed by authors, editors, or expert groups do not necessarily represent the decisions or the stated policy of the European Observatory on Health Systems and Policies. Printed and bound in the European Union. Suggested citation: Tragakes E, Brigis G, Karaskevica J, Rurane A, Stuburs A, Zusmane E, Avdeeva O and Schäfer M. Latvia: Health system review. Health Systems in Transition. 2008; 10(2): 1–253. ISSN 1817-6127 Vol. 10 No. 2 Health systems in transition Latvia Contents Preface ......................................................................................................... vii Acknowledgements .......................................................................................ix List of abbreviations .....................................................................................xi List of tables and figures ............................................................................ xiii Abstract ..................................................................................................... xvii Executive summary .....................................................................................xix 1. Introduction ..........................................................................................1 1.1 Geography and sociodemography .................................................1 1.2 Economic context ..........................................................................3 1.3 Political context .............................................................................8 1.4 Health status ................................................................................13 2. Organizational structure .....................................................................29 2.1 Overview of the health system ....................................................29 2.2 Historical background ..................................................................31 2.3 Organizational overview ..............................................................35 2.4 Decentralization and centralization .............................................49 2.5 Patient empowerment ..................................................................54 3. Financing ...........................................................................................61 3.1 Overview .....................................................................................61 3.2 Health expenditure .......................................................................64 3.3 Population coverage and basis for entitlement ...........................74 Population coverage .................................................................74 Benefits ....................................................................................77 3.4 Revenue collection/sources of funds ...........................................79 3.5 Pooling of funds ...........................................................................92 3.6 Purchasing and purchaser–provider relations ..............................93 3.7 Payment mechanisms ..................................................................95 iii Health systems in transition Latvia 4. Regulation and planning ..................................................................105 4.1 Regulation ..................................................................................106 4.2 Planning and health information management ..........................117 5. Physical and human resources .........................................................129 5.1 Physical resources ......................................................................129 5.2 Human resources .......................................................................145 6. Provision of services ........................................................................163 6.1 Public health ..............................................................................163 6.2 Patient pathways ........................................................................169 6.3 Primary/ambulatory care ...........................................................171 6.4 Specialized ambulatory care/inpatient care ...............................183 6.5 Emergency care .........................................................................191 6.6 Pharmaceutical care ...................................................................194 6.7 Rehabilitation/intermediate care ................................................198 6.8 Long-term care ..........................................................................199 6.9 Palliative care ............................................................................201 6.10 Mental health care ...................................................................203 6.11 Dental health care ....................................................................206 6.12 Complementary and alternative medicine ...............................207 6.13 Health care for specific populations ........................................208 7. Principal health care reforms ...........................................................211 7.1 Analysis of recent reforms .........................................................211 7.2 Future developments ..................................................................225 8. Assessment of the health system .....................................................229 8.1 The evolving objectives of the health system ............................229 8.2 Equity in access and financing ...................................................232 8.3 Efficiency of resource allocation in health care .........................234 8.4 Efficiency in production of health care ......................................235 8.5 Quality of care ...........................................................................237 8.6 Improvements in health status ...................................................238 9. Conclusions ......................................................................................241 10. Appendices ......................................................................................243 10.1 References ...............................................................................243 10.2 Further reading ........................................................................246 10.3 Web sites ..................................................................................248
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