Latvia

Health systems in transition
Latvia
and vaccinations, and onco-cytological consultations (cervical smears) for
women aged 18–65. The general conclusion has been that approximately 80%
of PHC physicians have been evaluated as “good” and received their bonuses
(SCHIA 2005).
A survey conducted in 2001 on patient satisfaction with their GPs by the
North-East Sickness Fund (no longer in existence at the time of writing)
found that patients were largely satisfied with the work of their personal GPs,
but were not satisfied with the referral system, patient fees and the system of
pharmaceutical reimbursement. In some cases concerns were expressed over
the following issues: the educational level of GPs; lack of confidence in the
GP’s ability; communication with the GP; management of GP practices; no real
choice of GP in rural areas; and the GP as a source of information on health care.
More issues of concern in primary care are discussed later in this section.
Changes in the primary care system over recent years
The development of PHC in Latvia has been strongly influenced by a number
of reforms that have taken place in recent years. A short history of PHC
development includes the following main points.
From the beginning of the reforms, the Government favoured the
establishment of private practices as a setting for primary care delivery.
According to the “Strategy for Health Care Development” prepared by the
Ministry of Welfare and accepted by the Government in 1996, “… primary
health care should be based on private medical practice, establishing a primary
health care development foundation and engaging various financial resources.”
The Primary Care Support Fund, PHARE and the World Bank equipped GP
practices through various projects from 1998–2002.
In 1998, as part of the transition to a PHC system, the sickness funds (that
were in existence at the time), in cooperation with local governments, developed
PHC plans on the basis of the existing structure of administrative regions
and the requirement of at least one family doctor per 2000 people. The list of
PHC physicians in 1999 consisted of 1362 doctors in three specialties: GPs
(44%), internists (31%), and paediatricians (25%). In 2004 these percentages
had changed in favour of GPs, as noted earlier, and were 80%, 14% and 6%
for each of these specialties, respectively. The number of certified GPs has
increased sharply in recent years due to retraining courses for GPs (supported
by the Primary Care Support Fund and the World Bank in 2001–2003), and
doctors who graduate as GPs from the Latvian Medical Academy becoming
involved in PHC.
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