Lithuania’s much-anticipated hospital network overhaul stalls

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With just one and a half year till the new parliamentary election, Health minister Aurelijus Veryga, the staunchest spearhead of the hospital network reform, said this week he will not pursue the major reform of Lithuania’s hospital network unless the Farmers and Greens (LFGU)-led coalition backs it fully.

The expensive and inefficient network of Lithuania’s hospitals needs an overhaul, but the country’s politicians have been procrastinating it for years, fearing that the public backlash will dent tangibly their support ratings.

Minister sidesteps for now

«Minister Veryga will no longer initiate the reform himself personally,» Lina Bušinskaitė-Šriūbėnė, an advisor to the minister, said to Lithuanian reporters this week. «But if the ruling coalition is united in its agreement that it is necessary and creates necessary legal pre-conditions to launch it, the minister will gladly take on the leadership, which he has publicly declared numerous times,» she added.

In her words, the minister’s attempts in the regard have so far ended up in failure.

She referred to veto of the health care system reform draft package by now outgoing president Dalia Grybauskaitė as an example. The head-of-stare was concerned among other things that, with the enactment of the legislation, patients would have been stripped of right to choose in what kind of hospital, state of private, to seek treatment.

After the ministry amended the draft accordingly, taking the bulk of the presidential proposals into consideration, it was then the Seimas (Lithuanian parliament) that did not endorse the amended draft. In one case, there were too few parliamentarians in the Seimas hall to have the draft registered.

«This just shows that big efforts to derail the reform have been put. Yet minister Veryga remains convinced that it, albeit very unpopular, is needed,» Bušinskaitė-Šriūbėnė emphasised to BNN.

Possible new coalition partners against reform

This way the ministry responded to a statement by the Order and Justice party leader Remigijus Žemaitaitis who said that it had been agreed during the ruling coalition talks not to launch the reform of regional hospitals. The party in in coalition expansion talks with the ruling LFGU.

«One of our requirements was not to initiate the regional hospital reform, for regional hospitals not to be closed. And such an agreement was reached by the negotiating team,» Žemaitaitis told journalists.

The other possible coalition partner, the Social Democratic Labour party (LSDLP), is also reluctant to include the topic in the agenda.

According to their leader, Gediminas Kirkilas, the reform has not been profoundly discussed and lacks clarity for both medics and patients.

«Our parliamentary fraction voted against the hospital reform law amendments. If passed, they would have doomed some hospitals and spike costs of medical services for patients. We are happy that we will not see hospitals getting closed down now. Our primary goal is to ensure accessibility and affordability of quality services to patients,» Kirkilas told BNN.

The elder of the LSDLP fraction, Andrius Palionis, noted that patients with lower income have to wait «many months” to get tested by, say, a magnetic resonance imaging (MRI).

«Meanwhile, private clinics assign such test for 200 euro already next day,» he said.

Too many fears, little support

The hospital reform envisaged that health facilities within the minister-approved network would have been given priority in signing contracts with Territorial Health Insurance Funds (THIFs).

Should it have happened, private inpatient facilities would have been given the right to conclude contracts with the THIFs only if they provided services that cannot be ensured by public hospitals.

Many of the amendments were planned to be put in effect from 2019, however President Dalia Grybauskaitė vetoed the bill last summer. The head of state sent it back to the parliament for its reconsideration, citing its incompatibility with the Constitution as the reason.

Many feared that, once implemented, the hospital reform would have left many small hospitals in the provinces only providing essential care and nursing. Only larger county hospitals would have been entitled with out-patient care and medical treatment.

Veryga stands his ground

Veryga argued that it was necessary due to the regions being plagued with high emigration and due to the demographics – seniors make up the majority in the hinterland.

The provincial municipalities’ mayors especially bristled against the reform locally, claiming that up to 80 per cent of the rural population of the districts receives urgent necessary assistance in local hospital admission sections. Importantly, some of the municipalities have invested in medical equipment in local hospitals.

«If implemented, the reform would have caused many inconveniences for people – they would have been transported several kilometre to the hospitals,» Algirdas Miklyčius, director of Varėnos Hospital, has told BNN.

If the hospital reorganisation plan had been approved, hospitals in the Lazdijai, Druskininkai and Varėna municipalities in southern Lithuania would have been added as divisions to the Alytus County Vincas Kudirka Hospital, a major medical hub in southern Lithuania. Should it have happened, the smaller hospitals would have been left with significantly smaller budget, thence layoffs would have ensued.

Veryga was also castigated for his plan to reduce the network of ambulatory care centres that are on the bottom chain of medical services and which are especially popular among the rural population. The vetoed reform, among other things, called for authorising the health minister to make decisions on the network of healthcare facilities and for setting good repute requirements for the heads of such facilities.

OECD report pointed out to shortcomings

Earlier this year, the European Commission concluded that it would be more efficient for Lithuanian to consolidate its hospital network. Brussels believes Lithuania’s healthcare system is no efficient enough as major attention is given to expensive hospital treatment, and too little attention is given to primary healthcare and disease prevention. The sector also lacks quality control, and patients covered by state healthcare insurance are still required to make fairly large additional contributions.

 A 2018 OECD report, acknowledging Lithuania’s progress in healthcare, notes that fewer adults in Lithuania report being in good or excellent health than in most OECD countries. Only 43 per cent of the population aged 15 years and above reports good or very good health while the OECD average is 68 per cent.

The report found Lithuanian health system too centred on hospitals. According to it, Lithuania is still one of the countries with the highest number of beds and hospitalisations per capita in the Organisation for Economic Co-operation and Development, OECD, and the bed occupancy ratio is below the OECD average in 85 percent of hospitals. Further restructuring hospitals to ensure complex services are delivered more safely in fewer facilities would improve quality and efficiency.

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