Healthcare system in Lithuania
In Lithuania, healthcare system legislation is based on several key laws such as the Law on the Health System (19.07.1994, No. I-552), Law on Health Insurance (21.05.1996, No I-1343), Law on Health Care Institutions (06.06.1996, No. I-1367), and numerous specific health regulations. The Law on the Health System describes the structure and the main principles of the national healthcare system in Lithuania. The healthcare system consists of the executive bodies, administrative bodies, resources, activities, and the range of services supplied by the healthcare system.
After the collapse of Soviet Union, there were efforts to change the Soviet healthcare model, in which healthcare was financed from the general budget, by introducing compulsory health insurance in Lithuania. Healthcare reform was implemented only partially (Gudžinskas 2012). Today, the healthcare system in Lithuania is a mixed system, predominantly funded from the National Health Insurance Fund through a compulsory health insurance scheme, supplemented by substantial state contributions on behalf of the economically inactive population, amounting to about half of its budget (Murauskiene et al. 2013). As a result, the governance of the system remained dependent on the general processes of the fiscal policy, and was more sensible to economic fluctuations and more open to political pressure (Gudžinskas 2012).
According to population surveys, the degree of overall satisfaction with the healthcare system varies from comparatively low to relatively high. The main problems of access to healthcare remain such as waiting times to access specialist services, geographical access to healthcare service in rural areas, and out-of-pocket payments remain high and could threaten healthcare access for vulnerable groups (Murauskiene et al. 2013).
Demographic change and health policy
Low fertility rates and high emigration rates do not ensure demographic balance and generational change. According to Statistics Lithuania, at the beginning of 2014, the estimated population of Lithuania was 2,943,500. In the period from 2004–15, the population declined by 455,500, or 15.5 %. In 2014, children aged 0-14 years made up 14.61 % of the total population, compared to 17.62 % in the beginning of 2004. Population ageing is reflected in the share of population aged 65 and older, which increased from 15.42 % in 2004 to 18.44 % in 2014 (Statistics Lithuania 2015).
Population decrease and population ageing influence the stability of the healthcare and social care systems in Lithuania. Healthcare and long-term care policy changes are considered an important component of the constructive response to population ageing. During the last decade, healthcare policy reforms focused on optimising the provider network and service restructuring, the optimisation of inpatient care, and the development of long-term and nursing services in Lithuania (Murauskiene et al. 2013).
Long-term elderly care
In Lithuania, long-term care is provided in two main sectors: health and social care. Long-term care is also provided by the private sector and non-governmental organisations (Marcinkowska 2010). The term ‘long-term care’ is defined in the Decree of the Minister of Social Security and the Minister of Health (04.07.2007, No. V-558/A1-183). According to this, long-term care is the entirety of care and social services by which the care and social needs of a person are met and continuous comprehensive help and supervision by specialists are provided.
During the period 2004-14, the number of nursing hospitals decreased from 66 to 48, and the number of beds in nursing hospitals increased from 3,421 (10.0 beds per 10,000 pop.) to 5,120 (17.5 beds per 10,000 pop.) (Health Information Centre 2005, 2015). The increase of the number of beds in nursing hospitals could be explained by considerations of population ageing. In Lithuania, long-term medical treatment with nursing services is funded by the National Health Insurance Fund, but for no longer than 120 days per year.
According to the Law on Social Services (19.01.2006, No. X-493), social services aimed at providing assistance to a person who, by reason of age, disability, or social problems, partially or completely lacks, has not acquired, or has lost the abilities or possibilities to independently care for his/her private life and to participate in society. The amount to be paid for the daytime social care provided to a person may not exceed 50-80 % of the person’s income.
During the Soviet period, the main long-term social care focus was on institutional care for elderly and disabled people. Starting from the independence of the Republic of Lithuania in 1990, the variety of public care institutions operated by the state, municipalities, and non-governmental bodies increased, and the development of non-institutional forms of care began (Murauskiene et al. 2013). According to the Ministry of Social Security and Labour, the orientation in long-term care is shifting from institutional care towards home-based care (Marcinkowska 2010).
The division between the healthcare system and the social services system remains the main problem of the long-term care system in Lithuania. In practice, coordination of the institutions involved in the long-term care process has not been assured (Marcinkowska 2010; Murauskiene et al. 2013).
- Gudžinskas, L. (2012). “Development of Healthcare in Lithuania and Estonia: Similar Conditions, Different Results”. Politologija 3 (2012): 61–94. ISSN 1392-1681.
- Lithuanian Health Information Centre. “Health Statistics of Lithuania 2004”. Institute of Hygiene Health Information Centre, 2005. Available at: http://sic.hi.lt.
- Lithuanian Health Information Centre. “Health Statistics of Lithuania 2014”. Institute of Hygiene Health Information Centre, 2015. Available at: http://sic.hi.lt.
- Marcinkowska, I. “The Lithuanian long-term care system”. ENEPRI Research Report No. 82, Centre for European Policy Studies, Brussels (2010).
- Murauskiene, L., Janoniene, R., Veniute, M., van Ginneken, E., & Karanikolos, M. “Lithuania: Health system review”. Health Systems in Transition 15(2) (2015): 1–150.
- Republic of Lithuania Law on Health Care Institutions 06.06.1996, No. I-1367.
- Republic of Lithuania Law on Health Insurance, 21.05.1996, No I-1343.
- Republic of Lithuania Law on Social Services, 19.01.2006, No X-493.
- Republic of Lithuania Law on the Health System, 19.07.1994, No. I-552.
- Statistics Lithuania. 2015. Available at: http://osp.stat.gov.lt
- The Decree of the Minister of Social Security of the Republic of Lithuania and the Minister of Health of the Republic of Lithuania on Approval of the Regulation on Provision of Nursing and Social Services, 04.07.2007, No. V-558/A1-183.