Latvia

Health systems in transition
Latvia
Table 3.5
Payment methods for health services
Family health care services
Dental services
Outpatient specialists
Laboratory tests and visual
diagnostics
Inpatient services
National programmes e.g. TB, Fixed budgets.
HIV/AIDS, infectious diseases
Source: Authors’ own compilation.
Capitation, additional fixed payments, fee-for-service payment
per specific activity, bonus payments.
Fee-for-service payment per activity according to tariff.
Consultant specialty-specific episode tariff, fee-for-service per
specific activity, flat rate payments.
Fee according to a tariff.
Bed-day tariff plus fee-for-service per specific activity, e.g.
operation and examination, case-based payment.
Outpatient services
In the mid-1990s, outpatient services began to be paid according to a “point
system”. Each service was assigned a number of points according to a scale
of service intensity. The payment of provider institutions (polyclinics) was
determined by the number of points corresponding to the services delivered
by doctors and nurses. This payment system proved to encourage costly
interventions and provision of a volume of services greater than necessary, and
was therefore gradually abandoned.
At the end of the 1990s, a capitation payment scheme was introduced for
GPs, who extensively began to change their legal status from employees in
polyclinics to self-employed in their own practices, which they either set up
individually or rented space within the facilities of polyclinics. Specialist
services were still paid according to the list of interventions.
At the time of writing, primary care services payment schemes also include
the addition of fees for defined activities and bonus payments. GPs also receive
fixed payments, such as a practice allowance, a PHC nurse allowance and some
additional payments for the number of chronically ill patients on their list.
Services provided by outpatient specialists receive a flat rate per episode of
illness. Every outpatient specialty has had its own specialty-specific episode
rate calculated. If specialists perform costly procedures, these are paid for
additionally for each episode according to specific tariffs. Patients have to pay
a patient fee in addition to the consultant episode payment. Diagnostic services
(lab, visual diagnostics) are paid for according to specific tariffs.
Several outpatient specialty services (such as psychiatry, TB, STIs, and
diabetes) are paid for by means of a flat rate mechanism, according to a budget
which includes salaries for personnel and costs of running the services.
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