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Health systems in transition Latvia • • • • invasive cardiology (coronarography, provided only in Riga at the Riga Stradiņs Clinical University Hospital); gynaecology (diagnostics, uterine curettage, biopsy); operations (surgical, such as varicose veins; inguinal hernia; ophthalmological, such as cataract; otorhinolaryngological, such as adenoids); rehabilitation. Day care hospital services are not yet highly developed in Latvia. In 2004, 318 676 patients were treated in 24-hour hospitals (13.6% of the Latvia population), compared with 19 946 patients in day care hospitals (0.9% of the Latvia population). The average number of bed-days per 1 patient in 24-hour hospital services is 10.8 days, while in day care hospital services, the respective number is 5.9 per patient (SCHIA 2005). If a patient cannot receive day care hospital services in the vicinity of her/his place of residence, s/he can receive it in outpatient medical institutions or in “ordinary” 24-hour hospitals. An exception is haemodialysis for chronically ill patients, which is performed as a day care hospital service in seven district multifunctional hospitals, four of which are in Riga, and in two in municipal multifunctional hospitals. In addition to hospital care, social care can also be provided in a day care setting. Social care is the responsibility of the Ministry of Welfare. Social services include the set of measures aimed at facilitating or improving the capability of individuals to satisfy their basic needs in the event that they face difficulties due to old age or functional disorders, and ensuring their integration into society. They include services at the patient’s place of residence, and in social rehabilitation and long-term social care institutions, as well as vocational rehabilitation services and provision of technical aids. In the social care context, a day centre is an institution which provides day care, that is, care within the course of a day, and includes development of skills, education and recreational opportunities. This service is provided for various groups of the population (elderly people, people with mental health conditions, etc.), and is financed by state and local governments. 6.5 Emergency care Emergency care is a health care service for a wide variety of conditions ranging from life-threatening emergencies to acute conditions due to diseases. Emergency care in Latvia is provided by: • EMA teams or ambulances (of which there are 173 in Latvia); 191
Health systems in transition Latvia • • 192 hospitals (emergency departments); the CEDM, a state-run, specialized medical service that covers only those cases when a CEDM specialist is called in by one of the hospitals, once it has been established that the institution’s own efforts and resources are insufficient to save the life of the patient. The surgical brigades of the CEDM come to help their colleagues in various district hospitals. They perform complicated spinal, neurosurgical and other urgent operations in hospitals, help to transport patients to the hospitals, and perform the crucial functions to sustain life while transporting victims. In cases in which the patients, their relatives or employers wishing to receive more qualified medical care call in the specialists of the CEDM themselves, the State does not cover the expenses. To ensure the rights of the patients to freely choose and receive highly qualified medical care, the CEDM also offers services paid by the patient and provides specialized medical care to patients both within and outside the borders of Latvia. An individual can receive emergency care services at 43 medical institutions contracted by SCHIA (hospitals have structural units of EMA teams or EMA services). Emergency care is available 24 hours a day. In Riga there are specialized emergency teams (intensive care, cardiological, psychiatric, children’s intensive therapy, etc.); elsewhere, there is usually one doctor and doctor’s assistant and the driver; in rural areas, there is a doctor and doctor’s assistant (in nine districts of Latvia), or two doctor’s assistants and the driver (in 17 districts of Latvia). EMA is provided to people whose life or health is in a hazardous and critical condition by specially prepared (trained, equipped) individuals with a relevant qualification in medicine. In case of emergency, one must call an ambulance (03 or 112), or go to the emergency reception of a hospital. Transport by ambulance is free of charge for patients. Key standards for ambulance services include: • responding to 75% of calls within 15 minutes in cities and towns (in reality from 4 to 15 minutes, on average 8 minutes); • responding to 75% of calls within 25 minutes in rural areas (in reality from 15 to 45 minutes, on average 22 minutes). The majority of primary emergency care involves sudden illnesses and acute conditions (64.8% of cases in 2003 and 63.0% in 2004). The second largest part of such care involves traumas and accidents (21.1% in 2003 and 22.4% in 2004) (HSMTSA 2005, HSMTSA 2006). Hospitals which have structural units of EMA teams and EMA services are contracted by the SCHIA, which finances these services from the health care budget. The contracts include:
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Health Systems in Transition Vol. 1
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Keywords: DELIVERY OF HEALTH CARE E
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Health systems in transition Denmar
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2. Organizational structure 2.1 Ove
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5. Physical and human resources 5.1
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9. Conclusions In the early years o
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10. Appendices 10.1 References Apin
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