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Health systems in transition Latvia The purchase of IT for health care institutions is not centralized. Each health care institution is responsible for acquiring its own IT by means of its own resources. All state agencies and specialized centres have homepages on the Internet. However, at the time of writing there were no accurate statistical data concerning the number of people who have used the particular homepages to receive information connected with health issues. Medical equipment, devices and aids According to article 34 of the “Law on Medical Treatment”, all matters relating to the distribution, registration, use and technical surveillance of medical devices and goods is to be determined by Regulations of the Cabinet of Ministers. The relevant Regulations came into effect in August 2005 (“Regulations on Registration, Conformity Assessment, Distribution, Use and Technical Surveillance of Medical Devices”). These Regulations specify that the HSMTSA is the sole body responsible for the registration, use, surveillance and distribution of medical devices. The conformity of medical devices is assessed by the HSMTSA, which is accredited by Latvia’s National Bureau of Accreditation. This Bureau, established in 1994, provides a common system for assessing the conformity of laboratories, including certification and inspection bodies, and environment verifiers. The purchase of medical devices and goods is mostly undertaken by medical care institutions on their own and in accordance with the “Law on purchases for the Needs of State and Local Governments”, adopted by Parliament in April 2006 (this legislation applies to all government purchases, not just in the area of health care). It is specified that purchases amounting to LVL 10 000 to 50 000 can be undertaken by use of public price inquiry, based on price information by all suppliers so as to obtain the lowest price. If the costs of the purchase are greater than LVL 50 000, they must be undertaken through competitive tenders. Procedures for centralized purchases in the area of health care are defined by “Regulations of the Cabinet of Ministers on Health Care Organization and Financing” (2004). These purchases are undertaken by the SCHIA, which acts as a payer on behalf of all institutions with which it has agreements (i.e. all statutory health care providers). As a customer (payer) of the purchase, the SCHIA buys vaccines, serums for immunology and immunoglobulins, preparations of phenylketonuria correction and curative food products. In addition, for all non-centralized purchases, the SCHIA acts as representative of the customer (the payer) in the capacity of manager of 139
Health systems in transition Latvia competitive procurement tenders. These procedures do not concern private sector institutions, which manage purchases on their own and also pay on their own. If the purchase of large medical technologies for hospitals is to be financed from state or local government budgets, the need, profitability, cost and conformity with modern technologies of the purchase are assessed by the Department of Project Assessment and Surveillance as well as by the Department of Health Care Analysis and Development within the HSMTSA (for example, medical radiology devices, anaesthesiology devices, operating rooms and intensive therapy, as well as other medical devices for diagnostics and treatment) (see Section 4.2 Planning and information management, as well as Chapter 7 Principal health care reforms for discussion on this). The need for a particular technology is assessed by analysis of statistical information regarding the number and load of the current technological level of existing medical devices. The purchase, which is carried out in accordance with the Master Plan, is intended to ensure patient access and a well-balanced geographical distribution of large medical devices within the country. For example, the HSMTSA refused the purchase by the Aizpute Hospital of a new Roentgen device, at a cost of LVL 200 000, which was to use state budget resources on the grounds of changes in population morbidity, the low load of the existing Roentgen device, as well as expected incorporation of this hospital into the new structure of a regional multi-profile hospital. In the case of large medical technologies in PHC, it should be noted that 90% of dental practices are equipped with dental Roentgen devices, which are financed by the practice (as most dentists are private practitioners), or, in the case of state dentistry centres, are financed by means of the procedure described above. In other practices (family doctors, internists, paediatricians) there is a lack of diagnostic radiological devices (Databases of the HSMTSA 2007 [unpublished data]). In other ambulatory health care institutions (both primary and secondary care levels), provision with this equipment varies, but on average it is quite low; for example, 1.7% of practices have fluorographs; 3.9% have radiological equipment, and 1.3% are able to offer ultrasound services (Databases of the HSMTSA 2007 [unpublished data]). Provision of medical technologies in inpatient health care institutions differs significantly. For example, 74.3% have radiological devices, 15.6% offer mammography services, 29.4% have computertomography equipment, and 54.1% offer ultrasound services. MRI and CT coverage per 100 000 is 0.3 and 1.8, respectively. The purchase of medical devices in state and local government health centres is carried out in accordance with the procedures 140
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Keywords: DELIVERY OF HEALTH CARE E
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9. Conclusions In the early years o
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