Latvia

Health systems in transition
Latvia
environmental hazards. In addition, the State Fire Inspectorate controls how
institutions comply with requirements to prevent fire hazards.
All health care organizations must be certified in order to qualify for
contracts with the SCHIA for provision of health care services under the
statutory system.
There is a continuous process of development of mandatory requirements for
health care organizations. New requirements for blood services were approved
in 2005 in accordance with EC Directives regarding standards of quality and
safety for the collection, testing, processing, storage and distribution of human
blood and blood components. New mandatory requirements for health care
institutions, including diagnostic facilities and medical laboratories are being
developed.
The Law on “Medical Treatment” (1997) also determines the process of
voluntary certification (accreditation) by use of national and international
quality system standards for assessment of health care institutions. The national
standards are still a subject of discussion among government policy-makers,
health care managers and health care professionals. At the time of writing, one
hospital has certified its quality system in accordance with ISO 9001:2000.
There is a general tendency to use more clinical practice guidelines, which
are usually developed by different associations of health care professionals.
Although some of these are produced on the basis of international guidelines,
as a result of revisions and adaptations to the local context there are some
doubts regarding their resulting quality. There is no formal responsibility for
the development of guidelines; therefore there is no common methodology
or formal mechanism for developing, approving and implementing quality
assessment guidelines. Moreover, whereas there is increasing interest among
health care managers and clinicians in the development of a system of health
care quality assessment by use of appropriate outcome indicators, the majority
of statistical data reflects productivity issues rather than problems related to
quality of care.
The body mainly responsible for overseeing quality of care issues is the
Quality Control Inspectorate for Expert Examination in Health Care and
Ability to Work, under the Ministry of Health. This agency has the right to
apply appropriate penalties to health care providers, including those that
operate without certification. In practice, very few non-certified institutions
are penalized.
There are ongoing discussions about establishing new standards for
accreditation of health care organizations. There is general agreement that the
standards should include most of the quality system elements, clinical processes
measurement and also outcome measurement. The goal is to create a more
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