Reform of the Lithuanian health system

1. Reform of the Lithuanian health system Martynas MarcinkevičiusAdvisor to the Minister of Health

2. Dynamics of Compulsory Health Insurance Fund’s Budget and Gross Domestic Product (GDP) from 1998 to 2011 Percentage of GDP 4,0 4,1 4,1 4,1 4,8 4,2 4,3 3,8 4,3 4,2 4,0 3,8 3,7 3,7

3. Number of beds and hospitals

4. 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)

5. 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

6. Reorganisation of the hospital network in 2010-2011

7. 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

8. 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

9. 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

10. 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)

11. Localisation of personal health care institutions by category Mažeikiai Skuodas N. Akmenė Joniškis Biržai Kuršėnai Kretinga Pasvalys Šiauliai Pakruojis Rokiškis Telšiai Plungė Panevėžys Klaipėda Kupiškis Radviliškis Gargždai Zarasai Kelmė Visaginas Šilalė Anykščiai Raseiniai Utena Kėdainiai Šilutė Ignalina Tauragė Molėtai Ukmergė Jurbarkas Kaunas Švenčionys Jonava Širvintos Kaišiadorys Šakiai Vilnius Kazlų Rūda Elektrėnai Marijampolė Trakai Prienai Vilkaviškis Region hospitals Alytus Kalvarija Šalčininkai District hospitals Lazdijai Varėna Druskininkai Municipalities without multi-profile hospitals

12. New Pharmaceutical Policyin Lithuania

13. 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

14. Means to save expenditures of the Compulsory Health Insurance Fund (CHIF) budget

15. Means to reduce patient expenditures on the purchasing of the medicinal product

16. Compulsory Health Insurance budget’s expenditure for reimbursed pharmaceutical and medical devices for ambulatory care, million euros 16

17. 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% +3.9% -22.6% +21,4% +20,7%

18. Changes in prices for medicinal products in2010 • 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.

19. Nearest plans and goals • Introduction of voluntary health insurance • Correct payment service (DRG etc.) • Quality assurance and measurement • Introduction of e-health

20. AČIŪ!