The State System
The Latvian health service is financed through national taxation. Local governments have a minimum amount they must spend on healthcare each year; they can exceed this amount but not fall short of it and they are unable to opt out of the state system.
The Basic Care Programme states the free care available for all citizens and registered foreigners in the country. It covers care of serious diseases, preventive healthcare, child and maternity care, emergency treatment, the treatment of sexually transmitted and infectious disease, surgery, rehabilitation, immunisation programmes and free prescription medicine to entitled groups. Free dental treatment is available for the under 18’s.
Employees must pay mandatory contributions to the social security fund. Full social cover costs 23,800 LVL a year and includes cover against accidents at work and sickness during employment. Employers must pay 24.09 percent for each employee and the minimum amount an employee can contribute for basic cover is 9 percent. Dependant family members are covered by the contributions paid by employed family members. Self-employed people must a minimum of 1,800 LVL per year - the same amount as an employed persons minimum mandatory contribution. The majority of vulnerable groups must only pay 50 LVL a year.
Foreigners immigrating to Latvia without jobs must produce proof of private health insurance in order to obtain their residence permit.
Citizens who belong to vulnerable groups of society e.g. pregnant women, war veterans, diabetics and tuberculosis patients do not have to pay any charges. Appointments with a doctor and referrals to a consultant are free. Fees have been increasing for state funded medical care and treatment like dental care for adults is now in the hands of the private sector. Any treatment not included in the Basic Care Programme has to be paid for, although in practice the system is not set up to manage the collection of additional payments.
Patients have to sign an agreement with their hospital if they are to receive treatment. The agreements outline the potential costs. The remaining costs are covered by the health fund. Prescription medicine is not free, but drugs for some conditions, like diabetes are free. People affected by the Chernobyl disaster are also exempt from prescription payments.
It is possible to take out private healthcare to pay for the cost of services not covered by the Basic Care Package, although in truth, the services offered private insurers provide the same as those by the Basic Care Package, although some do provide cover for dental treatment and prescription costs. They do provide access to a better range of facilities, medical staff and equipment. Only a small percentage of the population can afford private healthcare due to the low incomes earned in the country.
Doctors and Health Centres
Doctors are called doctorates and three quarters of them are women. Citizens can register with the doctor of their choice and are free to change up to twice a year. Truthfully, it is only city dwellers that actually have a choice because rural areas have few GPs. People seeking state medical care must make sure that their doctor is contracted into the state scheme.
GPs prescribe drugs, treat serious illnesses, provide preventive healthcare and health education. They are also responsible for providing referrals to specialists and hospitals. If you need a doctor out of the normal practice hours, you will have to visit a duty doctor.
Most town and city-based doctors operate out of health centres, which are owned by the local authorities. Rural clinics tend to be staffed by a doctor, a paediatrician, a dentist, a midwife, nurses and medical assistants. Some large companies and the military also have their own in-house clinic.
In the capital, Riga the clinics offer 24-hour emergency care and there a specialist teams to deal with various specialist areas of treatment like cardiology and psychiatry and some offer day surgery, alternative therapies and cosmetic surgery.
Consultants are senior doctors who have completed a higher level of specialised training. GP's refer patients to a Consultant if he believes that a patient may need specialist help and diagnosis. There are numerous specialist fields of medicine in Latvia, like gynaecology, oncology, paediatrics and dermatology. There is often a waiting list to see a Consultant doctor and they only work on a part-time basis.
Hospital care is provided by state general and district hospitals. There are around ten general hospitals in Riga.
District hospitals provide treatment for adults, paediatric care, treatment of infectious diseases, surgery and obstetrics. They have in and outpatient facilities and the people who staff them work for fixed salaries. The directors of city and district hospitals are appointed by the local health authorities.
Patients are free to choose the hospital they want to receive their treatment in, but require referrals from a GP. There are many specialist hospitals and each region has one for mental health, rehabilitation and tuberculosis. The conditions in some hospitals are poor.
Emergency care is available free for everyone including those without state health insurance. Emergency treatment is provided at the emergency room of all hospitals and emergency departments are open non-stop all year. You may use their services if you need immediate attention, or if your GP refers you to them, or if there is no GP service available.
Private clinics operate alongside the state system, but few citizens have the money to use them. Their funding comes through private heath insurance contributions and direct payments from private patients. Most can only offer outpatient treatment and the daily charges to private patients are very high.
Dental care in Latvia is mainly in the hands of private practitioners. Some dental treatment for children is available through the state healthcare system; otherwise, all treatment must be paid for out-of-pocket.
The Pharmacy Department is in charge of pharmaceutical legislation and policy as well as the control and licensing of pharmaceutical facilities. Drugs have to be registered via the Pharmacy Department and they are responsible for giving information about each medicine. You do not need a prescription for some medications and as a result, many people self administer their own medicine. The population has a high consumption of medicines and GP’s are influenced by the marketing activities of the pharmaceutical companies who manufacture or distribute the drugs.
More information can be found at www.vsaa.lv