Lithuania: health system review

ABSTRACT

This analysis of the Lithuanian health system reviews the developmentsin organization and governance, health financing, health care provision,health reforms and health system performance since 2000. TheLithuanian health system is a mixed system, predominantly funded from theNational Health Insurance Fund through a compulsory health insurance scheme,supplemented by substantial state contributions on behalf of the economicallyinactive population amounting to about half of its budget. Public financingof the health sector has gradually increased since 2004 to 5.2% of GDP in2010. Although the Lithuanian health system was tested by the recent economiccrisis, Lithuania’s counter-cyclical state health insurance contribution policies(ensuring coverage for the economically inactive population) helped the healthsystem to weather the crisis, and Lithuania successfully used the crisis as alever to reduce the prices of medicines. Yet the future impact of cuts in publichealth spending is a cause for concern. In addition, out-of-pocket paymentsremain high (in particular for pharmaceuticals) and could threaten healthaccess for vulnerable groups. A number of challenges remain. The primarycare system needs strengthening so that more patients are treated instead ofbeing referred to a specialist, which will also require a change in attitude bypatients. Transparency and accountability need to be increased in resourceallocation, including financing of capital investment and in the payer–providerrelationship. Finally, population health, albeit improving, remains a concern,and major progress can be achieved by reducing the burden of amenable andpreventable mortality.