HEALTH INSURANCE IN LATVIA

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1 HEALTH INSURANCE IN LATVIA Elina Tilta, Gaida Pettere At the present moment the health care system in Latvia is in transition period. During the Soviet time it was free of charge but at the present much of health care services is transferred to payable health care services that is the government institution doesn t assign money for this services and patient has to cover itself. Mention process is going slowly. Some years ago government municipalities covered 80 % of all expenses but now this coverage is 75% and part of them 25% had to be covered by patient himself. The basic model of health care in Latvia is: All territory of Latvia is divided into seven regions with one Sickness Fund. Every inhabitant of Latvia has to choose family doctor - internist (therapeutists). Every internist is working under some Sickness Fund. Therefore every inhabitant of Latvia is under any Sickness Fund. Number of family doctors is 966 in 2000 what are 4.0 per population. It is little part from all physicians working in Latvia (see Table No1). In the beginning of every year State distributes between Sickness Funds quotas in correspondence with number of population in every Sickness Fund. Further quotas are distributed between family doctors. Quotas are thought for some number free of charge manipulations (analyses, operations, visits to specialists). If quotas are used family doctor can sent his patents for further examinations or operations for money or he have to ask his patients to wait in queue while he will receive new quotas. Medical institutions later receive money in according to collected quotas by them. State is used large money for medical care (see Table 2) but the problem is very little solvency of

2 many Latvian inhabitants. For example, real wages for one people in Latvia is only 126% of the complete minimum consumer basket of goods and services but pension is only 69% of the complete minimum consumer basket of goods and services (see Figure 1). Therefore there are large queues for planned operations (at least half year before). This is moment, which would be favourable for insurance but problems are following: 1. antiselection for physical persons because people looking for insurance knows that they will need help of doctor in near future is about 80% of all cases, 2. state institutions are making many services possible only by money without previous information and claim expenses is growing for insurance companies, 3. it is pity to recognize but the control of doctors is not large enough and therefore about 30% of all claims are not based. Despite to all of that Health insurance market increases from year to year (see Appendix 4). The organization of Health insurance is following: Insurance companies have agreements with medical institutions. Medical institutions in the end of every month rapports to insurance company about services received by insured people. Insured people can receive free medical care only in these special medical institutions or they can pay themselves about services if they are agreed with family doctor and then receive money back from insurance company. Income replacement insurance doesn t exist because it is provided (Public) Social insurance. Long-term care insurance doesn t exist at all. At the present critical illness insurance doesn t exist too but will be provided in future. Health insurance products are divided in several levels and they are:

3 1. First and the most low-level policy (the most cheap, about 20 Lats) covers part of patient fee in an out-patient and in-patient institution. It means that insured take part in payments. 2. Second level policy (about 35 Lats) covers patient fee and patient copayment in an out-patient institution; and patient fee and patient copayment in an in-patient institution-hospital accommodation charges medicine and surgical fees. 3. Third level policy (about 45 Ls) covers the same of second level policy and additionally there is added coverage of special payable health care services or partly expenses about drugs. 4. Fourth level policy (about 50Ls) covers the same of second level policy and additionally there is added coverage of special payable health care services and partly expenses about drugs. 5. Fifth level policy (about 60Ls) covers the same of fourth level policy and additionally there is added coverage of additional facility services and basic dental program (partly payments about dental hygienist and ambulance service). 6. Sixth level policy (about 100 Ls) covers the same of fourth level policy and additionally there is added fully coverage of dental hygienist and partly covers dental service. 7. Seventh level policy (about 160 Ls) covers the same of fourth level policy and additionally there is added coverage of rehabilitation service and partly payments in different sports associations. 8. Eighth level policies are under wishes of every client (premium can be infinitely large, even about 500 Ls). To start from third level every client before buying insurance have to fill special form medical questionnaire.

4 To decrease claims paid out and anti selection all services have to be signed by family doctor. Generally, all policies have some days waiting period. Group insurance always have discount from any policy level. Until that time health insurance is working without actuary. The necessity of actuary can arise after some years if health care system fully becomes a private system fully paid by patent himself. That would mean large changes in health products and in premium calculations. References 1. Statistical Yearbook of Latvia, Central Statistical Bureau of Latvia, Riga 2000, 229 p. 2. Yearbook Insurance Private pension funds, Insurance Supervision Inspectorate, Riga 2000, 91 p

5 Appendix 1 Health Care Resources (2000) LATVIA Riga Number of hospitals (24)* Number of hospital beds per population (8371)* (110.2)* Number of physicians (including dentists) per population (2673)* 57.6 (35.2)* Number of personnel with secondary medical education (3684)* 83.6 (48.5)* per population Number of out-patient care institutions (304)* Appendix 2 Health Care Budget (2000) Indicator GDP, million US $ State health care budget, % of GDP 3.3 Health care purchasing budget of Riga sickness fund, million US $ 53,7

6 Appendix 3 Comparison of income and outcome of one average Latvian inhabitant Com parison ofincom e and outcom e ofone average Latvian inhabitantin LVL A verage gross monthly salary A verage realm onthly salary A verage size of old age pension Complete minimum consum er basketof goods and services per capita,yearly average Appendix 4 Dynamics of Written Gross Premiums and Claims Paid gross Dynam ics ofw ritten Prem ium s and Claim s Paid Written G ross Prem ium s Claims Paid gross

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