Transcript Slide 1

OECD REVIEWS OF HEALTH
SYSTEMS: LATVIA
Francesca Colombo
Head of OECD Health Division
Riga, 20 September 2016
Health in Latvia today
• Aging, shrinking population
• High prevalence of risk factors
• Quality and efficiency initiatives underway but
room for improvemen
• Under-funded system compared to OECD
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Next steps:
• Improve access to care
• Build a data-drive health system
• Strengthen preventive care
• Rise efficiency, strategic contracting
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1. HEALTH IN LATVIA
4
80
Source: OECD Health at a Glance Europe 2016, forthcoming
78.3
78.1
76.4
75.5
75.4
Years
83.3
82.7
82.2
83.3
83.2
82.8
82.3
82.1
81.9
81.8
81.7
81.6
81.5
81.4
81.4
81.4
81.3
81.3
81.2
81.2
80.9
80.7
78.9
77.9
77.8
77.4
77.0
76.0
75.0
74.7
74.5
74.5
Poor health outcomes
2014 1990
90
70
60
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Quality of care: room for improvement
⃰
Latvia
COPD and asthma: avoidable
hospital admissions
Around OECD average
Diabetes: avoidable hospital
admissions
Around OECD average
Prescribing antibiotics
Well below OECD average
AMI: 30 days mortality
Highest in OECD
Stroke: 30 days mortality
Highest in OECD
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Access to care: obstacles remain
Comprehensive service coverage
Waiting times are often long
High out-of-pocket payments
High unmet need
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Poorer Latvians report higher unmet need
Unmet need for medical examination (too expensive, too far to travel, or waiting time),
by income level, 2013
High income Average Low income
On average
13.8% of Latvians
report unmet care
needs, compared
3% across OECD
23 countries
Netherlands
Austria
Spain
Luxembourg
Czec h Rep.
Switzerland
Denmark
Norway
Germany
United Kingdom
Belgium
Slovak Rep.
Sweden
Hungary
Franc e
Portugal
O ECD(2 3 )
Lithuania
Ireland
Ic eland
Finland
Italy
Estonia
Poland
Greec e
Latvia
0
5
10
15
20
25
%
Note: OECD EU countries. Source: EU-SILC 2013.
1 in 4 of low
income
population
forewent care in
Latvia
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Cost: a main driver of unmet need
25.0
Self-reported unmet needs for medical examination: too expensive
20.0
15.0
10.0
5.0
0.0
Note: EU countries.
Source: EU-SILC 2013.
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Poor health care resources
may damage performance
Low public investment in health:
3.4% of GDP
High out-of-pocket spending:
38% of THE
Same practicing doctors as OECD
3.1 per 1 000 population
Nearly half the nurses as OECD:
4.9 per 1 000 population
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Health spending returning slowly to
pre-crisis level
Per capita GDP and health spending (in real terms) in Latvia, 2005 – 2015
(2005=100)
Source: OECD Health Data; OECD National Accounts Database
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But health expenditure remains low
Health expenditure as a share of GDP, 2015 (or nearest year)
16.9
% GDP
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Public
Private
14
12
10
8
6
11.5
11.2
11.1
11.1
11.0
10.8
10.6
10.4
10.3
10.2
9.9
9.8
9.6
9.4
9.4
9.3
9.1
9.0
9.0
8.9
8.8
8.4
8.2
7.8
7.6
7.4
7.2
7.2
7.0
7.0
6.3
6.3
5.9
5.6
5.2
16
4
2
0
Note: Excluding investments unless otherwise stated.
Source: OECD Health Statistics 2015, http://dx.doi.org/10.1787/health-data-en; WHO Global Health Expenditure
Database.
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2. TACKLING KEY CHALLENGES…
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Improving access to care
 Commendable efforts to improve access:




Opening rural practices
More nurses in primary care
Free hotel-accommodation for some groups
Physician assistant or “feldsher” role:
 Next steps
 Cost-sharing exemptions for vulnerable patients
 Assess if “quota” system is fit for purpose
 Focus on prevention
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Improve quality and data use
 Quality initiatives are underway:
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


P4P in primary care
Incentives for early cancer detection
Coordination in emergency and primary care
Electronic health record launch imminent
 Next steps:
 From minimum standards to quality improvement
 Build a data-driven system
 Open data publication and benchmarking
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Improve efficiency
 Certain efficiency gains:
 Reduction in hospital use, shift to outpatient
 Recent introduction of DRG system
 Centralised emergency triage system
 Next steps:
 More strategic contracting
 Better targeting of waste
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More resources may be needed
• To see health outcomes closer to the OECD average
• To tackle problems with access and quality
• For sustainable long-term performance
 Initial steps:
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


A spending review
A comprehensive five or ten-year plan
A workforce plan to assess and project need
Developing long-term care
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TO CONCLUDE…
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Key policy recommendations
Improve access to care
Focus on improving quality
Drive efficiency gains
Consider carefully increasing health spending
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Thank you
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