Health care reform: increasing coverage, accessibility and quality
With the adoption of the necessary legislation, the reform of health care institutions has entered the implementation phase. This summer saw the launch of a unified national Ambulance Service, the creation of a network of strengthened public health institutions and centers of excellence, the establishment of municipal health centers, and the creation of a network of hospitals with equitable geographic access and high-quality services by 2025.
"There are concerns in the public domain that all health services are concentrated in five large hospitals and that district hospitals will be closed. We would like to reassure the population that there is no basis for such fears and no hospitals will be closed. The most complex procedures, requiring expensive and innovative equipment and the highest level of specialists, together with support at all levels, will be concentrated in tertiary level and regional centers of excellence with university and republican hospitals in Vilnius, Kaunas and Klaipėda, and in five regions. Secondary level hospitals providing inpatient active treatment services will be in the regions of Lithuania and in ten districts, thus providing equitable access to the entire population.
As the population of district hospitals declines and the demand for inpatient services decreases, unoccupied but maintenance-intensive inpatient beds will gradually be transformed into high-quality and efficient day hospital and day surgery services that reduce the risk of complications and nosocomial infections and enable patients to recover faster, while rapidly expanding access to outpatient services and providing essential inpatient services. No hospitals will be closed," says Deputy Health Minister Danguolė Jankauskienė.
The number of day hospital services for uncomplicated health conditions is set to increase by 50% by 2030, while the volume of day surgery services is set to increase by 30% compared to 2019 figures. Positive trends are already being observed: according to the State Patients' Fund (SPC), comparing the data for the first half of 2019 and the first half of 2023 for these services, there is a 13% increase in the number of day hospital services and an 11% increase in day surgery services.
Safe, quality, and accessible hospital care for the population will be ensured by an evenly distributed network of facilities providing inpatient active treatment services. It is geographically organized so that emergency, intensive care, intensive care, surgical and therapeutic services are available to patients within 60 minutes. The network also requires facilities to provide more than one service profile, to meet the quality requirements laid down in a government decree, and to provide 24-hour emergency care. The network of facilities providing inpatient active treatment services will be in place by 2025, giving facilities time to prepare for the changes and implement the requirements.
Many of the health problems we are used to seeing in hospitals in Lithuania can be solved in outpatient settings. This is reflected in the number of avoidable hospitalizations, which in 2019 was 31.4 cases per 1,000 inhabitants, one of the highest in Europe. Therefore, one of the priorities of the reform of healthcare institutions is to strengthen the outpatient link by strengthening the family doctor team, expanding the range of personal health services to the home, creating municipal health centers and extending outpatient consultations to the population.
The Municipal Health Centre is a new form of organization of health care services, which helps to bring together the basic, i.e. the most essential services that are most frequently used by the population: primary and secondary specialized outpatient health care, mental health care, dentistry, nursing and palliative care, day hospitals, outpatient surgery, day surgery, emergency medical care, inpatient health care, public health care, and other services. The Health Centers will help ensure that at least 80% of health services are available closer to home, in their own or a neighboring municipality. By working together rather than just competing, public and private, primary, and secondary, outpatient and inpatient, personal and public health facilities will be better able to provide the full range of services needed by the municipality.
The Municipal Health Centre has already been launched this year in the Švenčionys District Municipality through the merger of the Švenčionys District Hospital and the Švenčionys District Primary Health Care Centre. By the end of this year, all municipalities in the country will have to decide on the establishment of health centers, after assessing the efficiency of all the medical facilities in their territory, the number of services currently provided and the projected need for them.
Patients in the health centers will be cared for by an expanded family doctor team, which is expected to be fully staffed by 2030.It will include a family doctor, general or advanced practice nurses, a midwife, a case manager, a physiotherapist, a lifestyle specialist, a ward administrator, and a social worker.
To ensure accessibility of the services, a patient transport service is being introduced, which will be available to patients who, for social or economic reasons, cannot use private or public transport. The pilot project is currently running in 20 municipalities across the country and will be available nationwide from July 2024.
Such a rational network of health care institutions, providing quality services and coordinating with each other for the well-being of patients, will be able to provide accessible services to all Lithuanian citizens, regardless of where they live. However, this will require significant changes in service management and network governance, which are a considerable challenge for health workers and health service organizers to master.
Last updated: 04-01-2024
Related news:
Minister for Health A. Pečkauskas attends the Health Systems Sustainability Conference in Brussels
Minister of Health A. Pečkauskas attends child nutrition event in Kyiv
Technical cooperation agreement on health signed with Ukraine
Ministry of Health launches social campaign "Bribery is a bad habit"