Latvia

9. Conclusions
In the early years of the reforms, much of the impetus for change in Latvia
derived from the desire to establish new conditions marking a sharp break
with the Soviet past. In spite of the political turbulence and economic collapse
in the initial period following independence, reforms in the area of health care
were initiated almost immediately, based on the belief that change should aim
towards establishing continuity with the prevailing conditions in 1940, prior
to Soviet annexation, and moreover should hasten the process of convergence
with the EU. Weaknesses of the Soviet health care system, including extreme
inefficiency, inflexibility and centralization, and the absence of incentives for
cost–effectiveness and quality improvements, united all stakeholders in the
commitment to bring about change that would address existing shortcomings
and modernize the health care system.
Reforms in the early years therefore concentrated on decentralization in
financing and provision, privatization, the introduction of a primary care system
based on independent GPs, establishment of a social health insurance structure,
and introduction of a fee-for-service payment system for doctors.
Some of these reforms were more successful than others. Perhaps the greatest
success was achieved in the establishment of a system of PHC based on the
new organizational structure of independent practitioners who retrained in the
new specialty of general practice. The greatest challenges and obstacles were
encountered in the extreme decentralization of financing, and in the introduction
of fee-for-service payment methods. Accumulating experiences with the various
aspects of newly introduced structures and activities was a major factor behind
the evolution of thinking about how to proceed with further reforms, offering
successive governments and reform-minded stakeholders opportunities to learn
from past mistakes and modify reform objectives accordingly.
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