Latvia

Health systems in transition
Latvia
faces a financial incentive to retain the money that would otherwise be paid
to a specialist. Patients fear that they may receive inadequate or inappropriate
treatment in the event that their condition requires specialist knowledge and
skills. Specialists themselves similarly oppose the arrangement as their position
vis-à-vis the family practitioners is severely weakened. The incentive system for
GPs is discussed in more detail in Section 3.7 Payment mechanisms, Subsection
Paying health care personnel.
From the point of view of patients, according to a major survey of the
population (by the Tropical Disease Research Centre (CIET)), a change in the
health care system that was most often cited involved the practice of family
doctor referrals to specialists. More than half the respondents would be willing
to pay higher patient fees in order to have easier access to specialized care.
6.4 Specialized ambulatory care/inpatient care
Secondary ambulatory care
Secondary ambulatory care can be received at the institutions listed here (see
also Figure 6.3).
• Specialist physician practices; these consist of specialist doctors who work
independently either as self-employed individuals or as private sector agents.
The institutional legal forms here are exactly as in the case of GP practices
(discussed earlier), where a self-employed practitioner pays income taxes on
the basis of income earned in the practice, while the premises and equipment
of the practice are either privately owned or rented. Most specialists run
independent practices in rented facilities of former polyclinics owned by
local governments. Limited companies come under the category of “private”
and are taxed as such.
• Hospitals; these may be owned by the central Government under the
jurisdiction of the Ministry of Health, or owned by local governments, or
they may be private.
• State agencies (such as the State Centre for Mental Health, Tuberculosis
and Lung Diseases Centre, Centre for Infectious Diseases, etc.) come under
the Ministry of Health.
• Diagnostic services fall under the ownership of the central Government or
local governments, or they may be privately owned.
• Health centres may be public (owned by local governments) or private, or
operate under a public–private ownership mix.
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