National CVD Prevention Coordinator for Lithuania
Rimvydas Slapikas, FESC
Professor, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania
Documents to download
In the late 1990s, Lithuania moved away from a system funded mainly by local and state budgets to a mixed system, predominantly funded by the National Health Insurance Fund (NHIF) through a national health insurance scheme and based on compulsory participation. The state health-care system is intended to serve the entire population, and the Health Insurance Law requires all permanent residents and legally employed non-permanent residents to participate in the compulsory health insurance scheme (typically paying 6–9% of taxable income).
Over the last 2 decades after regaining independence, Lithuania entered a new era with many opportunities for radical improvements; nevertheless, the population of the country has been exposed to the new and unfamiliar social environment, and consequently, experienced tremendous stress. The first decade of independence was the period of major socioeconomic changes, and it was expected that society would gradually enter a more stable stage of development. However, the second decade was marked by an economic crisis and continuing reforms in health system and related areas. Mortality is one of the major indicators reflecting the changes in health outcomes. Several studies carried out in Lithuania have analysed trends in mortality from major causes: they provided average annual changes assuming that rates increase or decrease at a constant rate over time, and some identified the calendar years in which changes occurred.
Main actors & prevention methods
The key document, the National Health Concept (Supreme Council of the Republic of
Lithuania, 1991), outlined new approaches to healthcare, including introduction of the concept of health insurance, prioritising disease prevention and developing primary care.
Another core document, the Lithuanian Health Programme (for the period of 1998-2010), introduced a set of objectives for population health. The programme covered major health issues, including cancer, injuries, cardiovascular and communicable diseases, mental and oral health, and risk factors, with a particular focus on reduction of alcohol and tobacco consumption and drug abuse.
Based on the unfavourable situation with cardiovascular morbidity and mortality the Lithuanian High Cardiovascular Risk (LitHiR) programme aimed at estimation and aggressive managing of cardiovascular risk factors has been launched in 2006. The programme aimed at estimation and managing of cardiovascular risk factors striving to reduce acute cardiovascular event related morbidity and mortality, to slow down the progression of sub-clinical atherosclerosis into overt cardiovascular disease. It also aimed at increasing the number of newly identified cases of diabetes, metabolic syndrome and latent course of atherosclerosis related diseases and decreasing hospitalisations for treatment of arterial hypertension and coronary heart disease.
Medical rehabilitation in Lithuania has been developed in three stages: first, the introduction of physiotherapy; second, the development of multi-profile rehabilitation; and third, the development of a comprehensive rehabilitation system. Licensed providers of rehabilitation services are paid by the NHIF. The cost of the first rehabilitation stage (interventions provided at the health-care facility where the patient is treated) is included in the price of the treatment. Further (second-stage) rehabilitation is provided in specialised rehabilitation units, in general hospitals and in specialised hospitals and sanatoria. Rehabilitation units have to meet the criteria for minimum number of beds and the requirement of service availability for six days per week. The third rehabilitation stage requires either outpatient or tertiary level rehabilitation.
Aims for the future
Although the Lithuanian health system was tested by the recent economic crisis, Lithuania’s state health insurance policies (ensuring coverage for the economically inactive population) helped the health system to weather the crisis, and Lithuania successfully used the crisis as a lever to reduce the prices of medicines. Yet the future impact of cuts in public health spending is a cause for concern and out-of-pocket payments remain high (in particular for pharmaceuticals) and could threaten health access for vulnerable groups. A number of challenges remain:
- The primary care system needs strengthening so that more patients are treated instead of being referred to a specialist, which will also require a change in attitude by patients.
- Transparency and accountability need to be increased in resource allocation, including financing of capital investment and in the payer–provider relationship.
- Population health, albeit improving, remains a concern, and major progress can be achieved by reducing the burden of amenable and preventable mortality.
The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology