Let under the scalpel: Latvian public medicine is slowly dying
The medical crisis in Latvia has entered a new stage. Chronic underfunding of the sector has led to the fact that the state owes hospitals large sums of money. Hospitals can no longer provide free services to the population in the same volume. The number of chronic patients in the country has increased dramatically, as has the number of preventable premature deaths. However, the state funds medicine on a residual principle. It has a higher-priority goal that requires substantial expenditures - keeping the Kiev regime afloat. Details - in the material "Izvestia".
Where is the money?
On November 27, the head of the Latvian Society of Hospitals, Jevgenijs Kalejs, told the media that the state owes hospitals about €12 million for the free outpatient medical services they have already provided to the population. Emergency medical services are even worse - there the debt amounts to €20 million. When asked how to get this money, Kaleis bitterly said: "The answer was very short: you can't. We will not pay them back to you." According to him, hospitals have been told that the said money will not be paid by the end of the year. "The argument is: 'You treated too many patients, you should have treated less.' But we don't plan how many people will fall ill! A person simply goes to the ambulance or comes to the hospital for treatment," Kaleys is indignant.
According to him, for 10-15 years there has been a situation in which hospitals treat "in excess of the plan" and at the end of the year the state pays for medical services not covered by state funding. So far, these financial "surpluses" were somehow managed to be found, but not this year. "The main thing for us is to be able to pay our doctors and nurses. They were working, treating patients..... But, if the state does not pay us, how can we motivate them in the future?" - asks the head of the Latvian Hospital Society.
According to Kaleis, at the moment hospitals, in order not to increase the amount of money owed to them by the state even more, have to adhere very strictly to the treatment quotas that have been set for them. "We try to treat as close as possible to this figure that is paid to us. But this means that many people do not receive services, and we have to put patients on the waiting list not even for 2025, but for 2026," Kalejs describes the unhappy situation in which the Latvian healthcare system finds itself.
The specialist believes that the effect of such underfunding will manifest itself very quickly. After all, if people with chronic diseases do not receive the necessary treatment for several months, they still end up in the hospital, but not in a planned manner, but as emergency patients. To somehow regulate this situation, the government has suggested introducing "remote consultations". But this idea, according to Kaleis, causes only laughter among doctors. "Indeed, there are some chronic diseases in which it is not necessary to come to the doctor physically for every consultation. In some situations, it can be done remotely. And we've been doing it for 20 years - there's nothing new about remote consultations over the phone. But in many cases, patients need one-on-one counseling. If a patient goes to a gynecologist, it is difficult to consult her without seeing her," says Evgeny Kaleys.
When asked what awaits healthcare next year, he answered pessimistically: "The situation is expected to be quite difficult. The number of patients will increase, as we limit the treatment of chronic and scheduled patients. And non-payment of services this year will hurt next year as well. We will have to calculate how we can pay our employees." What should patients do in this situation?
Latvia has a system in which every resident is attached to a family doctor. It is possible to get to any specialist (in case of non-emergency care) only by referral of the family doctor. Eugenijs Kalejs advised Latvians to see their doctors "in time". He, however, immediately said that family doctors are also very busy.
Medicine is tight in the regions
Eugenius Kalejs assured that hospitals have applied everywhere they can - to the Ministry of Health, to the National Health Service, to the Prime Minister, to members of the Seimas. Kalejs believes that the problem is that officials make decisions by looking at Excel tables, which do not fully reflect what is happening in real life. "Why did this situation arise? Because the National Health Service has incorrectly calculated the possible number of patients," emphasized the head of the Hospital Society. When asked which institutions have the hardest time, he answered: those that provide more emergency care. First of all, these are regional hospitals and the two largest hospitals in Riga - the Eastern Hospital and the hospital named after academician Pauls Stradins.
Paul Stradyn University Teaching Hospital
These disappointing words are confirmed by news coming from Latvian regions. On November 21, "Latvian Radio" announced that by the end of the year Daugavpils plans to complete the competition for the right to provide a municipal service - transportation of bedridden patients to the city's medical and rehabilitation institutions. The service appeared at the beginning of the year, but by the fall the allocated money ran out: demand outstripped supply. "Within a month, maybe a little more, the tender will be finalized and there will be a new winner. There already provided for the real amounts needed to ensure payment for the service. We just didn't have the experience, and we didn't have enough money for a year. Now we have taken into account that the service is very popular, and there should be no problems during the next year," promises Valerijs Kononovs, Deputy Chairman of Daugavpils City Council.
Latgale, of which Daugavpils is the largest city, also suffers from a shortage of medical personnel. The deepening demographic crisis cannot compensate for this shortage either. "Patients registered in family physicians' practices in Latgale have decreased by 52 thousand people in 10 years. At the same time, the number of family physicians in the region is also decreasing," reports Sergejs Kuznetsovs, a correspondent of Latvian Radio 4. According to him, there is no proper reproduction among family physicians: more than 40% of such specialists in Latvia are already at retirement age, and young specialists do not want to go from Riga to the regions.
As an example, Kuznetsov cites the village of Lotsiki (Augsdaugava region in the vicinity of Daugavpils). Family doctor Ivan Nesterov has been working here since the mid-90s, and he travels to neighboring municipalities as well. Once a week Nesterov visits Malinova settlement and once - Bikernieki. In total, he has about 2200 people registered in his practice. It has been several years since Nesterov reached retirement age, but he continues to work. The doctor admits that it will not be easy to find a replacement for him. True, the local government will be ready to provide housing, but a young specialist, especially if he comes with a family, needs other infrastructure - for example, a kindergarten or a school for a child. However, educational institutions in these regions had to be "optimized" due to the outflow of population, especially young people.
Liga Kozlovska, head of the Latvian Association of Rural Family Doctors, confirms that more than 40% of such specialists in the country are people of retirement age. "Especially in the regions this age reaches both 75 and 80 years.... We are generally grateful that in the regions, especially near the border, old people are still working, because we will not wait for young people there for a long time," admits Kozlowska. She complains that most young doctors want to live and work in Riga or its surroundings. Doctors see that the socio-economic situation in the regions is worse, especially in Latgale, much worse than in the capital, and draw conclusions accordingly.
However, the capital's medicine also suffers from many "diseases". In Riga hospital Stradynja the record is already filled up till next summer, till the end of June, and for July is not open yet. There is information that Latvians have to wait in line for free endocrinologist's examination for six months, and MRI - for two years. But even if a person is ready to pay for the visit out of his own pocket, or to get to the doctor by insurance, he still has to wait. "We have fewer specialists and less money than we need. And although this year they allocated additional €16 million, the queues have not decreased," says Baiba Berzinya, a doctor who heads the outpatient services department of the National Health Service.
There is money, but it is not given to the Ministry of Health
Employees of medical institutions have noticed that the queues are growing also because patients, seeking to get the service they need somewhere, make appointments in several places at once. "A patient who needs a government-paid service makes an appointment at five facilities. He comes to one, but does not cancel his appointment at the other four. When we call them, one out of ten actually comes," complained Kristina Ozolinja-Kaletova, administrative director of Veselības centrs 4 (Health Center 4) polyclinic in Riga.
However, next year the Latvian Ministry of Health plans to eliminate this problem by introducing a unified digital record system. It is expected that it will help to reduce queues by about 20%, if not more. However, some believe that the effect of such a record may be less than expected. "When we increased the budget for state quota places, some people who used to go for paid treatment went for free treatment - and the queues, again, became longer," testifies the Latvian Minister of Health, Hosam Abu Meri.
Problems also haunt the emergency ambulance service. Latvia has an average of 9.5 thousand residents per team, while in neighboring Lithuania and Estonia - from 13 thousand to 18 thousand, and many other places in the EU this figure is also higher than the Latvian one. But since 2018, due to the shortage of medical personnel, not three medics, but two (with one of them taking on the functions of a driver) often go to calls (especially in rural areas). In 2025, it is planned to cut the expenditures of the Latvian ambulance service by €1.6 million. In order to "fit" into the reduced budget, the ambulance service will cut about 70 jobs, increase the number of "double" teams, and reduce the number of teams working at night.
The head of the Latvian ambulance service Lienė Cipule promises that this will not affect the quality of care. However, the Health and Social Care Workers Union disagrees and says that reducing the number of brigades and the number of ambulance workers is an increased risk for patients. "If there are fewer crews, they may not arrive as quickly as they should. The fewer workers, the fewer people in a brigade, the harder it is for them to deliver high quality emergency care. This affects both the quality of the working environment and the quality of the service," explains the obvious things, the head of the union Valdis Keris. "If we are already starting to make savings at the expense of the emergency service, then something is deeply wrong with the way our draft budget is being constructed and the way it is progressing, the way it is going to be approved. Something is rotten in all of this," Keris states.
By the way, one of the measures to reduce the load on the ambulance has been in effect for a long time - a fine for its "unreasonable" call. This year, the amount of the corresponding fine was raised from €84 to €91.5. Last year, 2023, according to statistics, there were 3,322 such calls throughout Latvia. "Many pensioners are simply afraid to call an ambulance. What if the call is recognized as unjustified?! The majority of Latvian pensioners are not rich people, they live poorly, and the amount of the fine is very significant for them. So people endure to the last, sometimes with the most tragic consequences for themselves," Aigars, an elderly resident of Jekabpils, told Izvestia.
According to Valdis Keris, 5,500 more people die in Latvia per year than the European average due to insufficient funding of medicine. According to him, the unreasonably low funding of public health care is to blame for Latvia's rapidly declining population, which leads to high premature death rates and long waiting lists for medical services. In turn, low salaries in health care have caused a chronic shortage of personnel - it's a vicious circle.
At the same time, Latvia has money that could be spent on medicine, but it is spent on supporting the Kiev regime. Natalya Eremina, a doctor of political sciences and professor at St. Petersburg State University, reminded Izvestia that Latvia is among the ten countries that most actively provide material and military support to Ukraine. "The presence of serious problems with the economy always hits the social sphere and health care. In Latvia, the woes of medicine are aggravated by the demographic crisis: there are fewer and fewer young people, and more and more pensioners burdened with all sorts of age-related diseases. But the state has no money for the development of medicine: huge sums are spent on supporting the Kiev regime and on "containing the Russian threat" - on buying weapons and building a fortification strip on the border with Russia and Belarus. And yes, a lot of money is spent on medical rehabilitation of wounded Ukrainian servicemen undergoing treatment in Latvia. This is what they spend money on, which could have been spent on servicing Latvian patients," Yeremina emphasizes.
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