Reform of the Lithuanian
health system
Martynas Marcinkevičius
Advisor to the Minister of Health
Dynamics of Compulsory Health Insurance Fund’s Budget
and Gross Domestic Product (GDP) from 1998 to 2011
111,5
GDP, bil. LTL
98,1
CHIF budget, bil LTL
92,0
95,7 98,8
82,8
Percentage of GDP
72,1
62,7
44,7 43,7 45,7
4,3
48,6
52,1
4,2 4,0
57,0
3,8
3,7
3,7
3,8
4,0
4,1 4,1
4,1
4,8
4,2
4,58 4,46 4,0
1,94 1,83 1,83 1,87 1,92 2,1 2,39 2,89 3,41 4,0
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
4,3
4,2
2011
plan
Number of beds and hospitals
Lovų skaičius 1000 gyv.
Ligoninių skaičius 100 000 gyv.
9
8
5
7
4
6
5
3
4
2
3
2
1
1
Šaltinis: Europos sveikatos duomenų bazė. http://www.euro.who.int/HFADB
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Šaltinis: Europos sveikatos duomenų bazė. http://www.euro.who.int/HFADB
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Health care system reforms. Funding



Transition from the budget-based to the
insurance-based system
Patient fund institution (1997)
All health care institutions became public
institutions (1997) (according to the pattern of
state limited companies)
Health care system reforms. Health care
institution



Introduction of General Practitioner
institutions (nearly half of them are private)
Three stages of hospital reduction
(2002,2004,2010-2011)
Expansion of the network of nursing hospitals
Reorganisation of the hospital
network in 2010-2011
Reorganisation of hospitals. Goals

Goals




Improving the quality of treatment and patient security
Strengthening the primary care and outpatient levels by
transposing funds and professionals from the in-patient
level
Efficient use of existing resources
Trends


Restructuring of health care services (RRR reform)
Optimisation of the network of health care institutions
Region and district hospitals


Region hospitals must meet two basic
criteria: more than 1,100 major surgeries and
more than 300 childbirths
District hospitals



With surgery and obstetrics (if tending to over 300
childbirths)
With surgery (if performing over 660 major
surgeries)
Without surgery and obstetrics
Optimisation of the hospital network and
services (ongoing)


The number of health care institutions (legal
entities) decreased by 11
More than 70 different services (surgery,
obstetrics, neurology, psychiatry, cardiology,
etc.) are no longer bought from different
hospitals
Optimisation of the hospital network

Principles:



Integrating mono-profile hospitals into multi-profile
ones
Merge geographically proximate institutions
Network:




2 University research and treatment centres
8 National level hospitals
8 Regional level hospitals
39 District level hospitals (including 10 with surgery
and obstetrics unit and 12 with surgery unit)
Localisation of personal health care institutions by category
Skuodas
Mažeikiai
N. Akmenė Joniškis
Kuršėnai
Kretinga
Klaipėda
Plungė Telšiai
Šiauliai
Biržai
Pasvalys
Pakruojis
Panevėžys
Gargždai
Rokiškis
Kupiškis
Radviliškis
Zarasai
Kelmė
Šilalė
Utena
Kėdainiai
Šilutė
Tauragė
Visaginas
Anykščiai
Raseiniai
Molėtai
Ukmergė
Jurbarkas
Kaunas
Jonava
Kaišiadorys
Šakiai
Kazlų Rūda
Marijampolė
Vilkaviškis
Region hospitals
Švenčionys
Širvintos
Vilnius
Elektrėnai
Trakai
Prienai
Alytus
Kalvarija
Šalčininkai
District hospitals
Lazdijai
Varėna
Druskininkai
Municipalities without multi-profile hospitals
Ignalina
New Pharmaceutical Policy
in Lithuania
Goals of the Plan



Stop growth in expenditures of the
Compulsory Health Insurance Fund on
reimbursable medicinal products
Reduce public expenditures on all
medicinal products (reimbursable/non
reimbursable)
28 measures of the Plan Involve all
players of the pharmaceutical market:
manufacturers of ethic/generic medicinal
products, wholesalers, pharmacy chains,
individual pharmacies, medical doctors
and competent authorities
Means to save expenditures of the Compulsory
Health Insurance Fund (CHIF) budget
Options for
clustering
medicinal
products
in the
Price-list
1 producer
original
Expenditures of
the CHIF on the
reimbursement of
medicinal
products for the
year 2008
352.469.704
Clustering
medicinal
products of
the same
therapeutic
action for the
basic price
15 mln LTL
Clustering
medicinal
products
of the same
active
substance
for the
basic price
3 mln LTL
Price-cutting
of the
generic
medicinal
products
Valid at the
moment
(expenditure
reduction 10
mln LTL in
year 2009)
1 producer
generic
12.856.132
2 producers
93.478.775
5 mln LTL
3 producers
29.814.468
3 mln LTL
4 producers
147.433.243
Total
636.052.322
Reimbursement of
complex
medicinal products
according to the
lowest price of the
component
5 mln LTL
Signing
agreements on
the limitation of
expenditures
Protects from the
uncontrolled
rise in
expenditure
5-10 mln LTL
The unification
of retail
prices and
copayments
5-10 mln LTL
Predictive saving for the calendar year ~ 50-60 mln LTL
Means to reduce patient expenditures on the
purchasing of the medicinal product
Setting maximum
mark-ups
for
prescription
medicinal
products
The unification
of retail
prices and
copayments
Obligation to present
visual information about
the prices and other
means to strengthen
control over the sales of
medicinal products
Obligation of doctors to
prescribe the exact quantity
of medicinal product
Obligation if doctors
regarding
rational pharmacotherapy
40-60 mln LTL
20-40 mln LTL
20-30 mln LTL
5 mln LTL
5-10 mln LTL
Predictive saving for the calendar year ~ 90-145 mln LTL
Compulsory Health Insurance budget’s expenditure for reimbursed
pharmaceutical and medical devices for ambulatory care, million
euros
300
217
201
200
186
170
147
127
100
93
94
93
103
89
93
89
125
94
105
99
110
107
122
139
155
179
198
202
189
2006
2007
2008
2009
2010
0
1998
1999
2000
2001
2002
2003
CHIFB Expenditure for pharmaceutical and MD
16
2004
2005
CHIF budget for pharmaceutical and MD
2005/2010 ratio between reimbursable amount for
medicinal products and MA and the patient mark-up
amount (mln LTL) as well as dynamics of patient mark-up
+20.9 %
1000,0
+20,7 %
205,7
800,0
213.8
165,4
170,1
700,0
mln. Lt
-22.6%
+21,4 %
900,0
600,0
+3.9 %
141,1
116,9
500,0
400,0
300,0
480,4
538,4
624,4
683,2
696,2
653,3
200,0
100,0
0,0
2005
2006
Reimbursed amount, Lt
2007
2008
2009
Patient mark-up amount, Lt
2010
Changes in prices for medicinal products
in 2010





After introducing regulation of prices for non-reimbursable
medicines, prices for medicines decreased by around 10% (by
approximately 30 mln LTL).
The average mark-up on prescription for reimbursable
medicines decreased by as much as 22.6%, and patients saved
around 49 mln LTL.
For the first time since 2002, a reduction in expenditure of the
Compulsory Health Insurance Fund budget on reimbursable
medicinal products has been recorded. In 2010 expenditure on
medicines was by 6%, or 43 mln LTL, lower than in 2009.
In 2011, the decreasing trend in prices and patient mark-ups for
medicinal products remains.
Savings will enable starting to reimburse new modern
medicines and to include new diseases and indications.
Nearest plans and goals




Introduction of voluntary health insurance
Correct payment service (DRG etc.)
Quality assurance and measurement
Introduction of e-health