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Health systems in transition Latvia Fig. 1.2 Levels of child vaccination against measles in the WHO European Region, 2004–2005 Kazakhstan 2005 Hungary 2004 Uzbekistan 2005 Belarus 2005 Turkmenistan 2005 Monaco 2004 Kyrgyzstan 2005 CARK 2005 Russian Federation 2005 Azerbaijan 2005 Poland 2005 Slovakia 2005 CIS 2005 Andorra 2004 EU Member States since 2004 Lithuania 2005 Albania 2005 Finland 2005 Republic of Moldova 2005 Czech Republic 2004 Spain 2005 Romania 2005 Eur–B+C 2005 TFYR Macedonia 2005 Netherlands 2005 Bulgaria 2005 Israel 2005 Estonia 2005 Ukraine 2005 Serbia 2005 Croatia 2005 Luxembourg 2005 Sweden 2005 Denamrk 2005 Latvia 2005 Armenia 2005 San Marino 2005 Slovenia 2004 Tajikistan 2005 European Region 2005 Germany 2005 Portugal 2005 Georgia 2005 EU 2005 Turkey 2005 Austria 2005 Norway 2005 Bosnia and Herzegovina 2005 Iceland 2005 Eur-A 2005 EU Member States before May 2004 Belgium 2005 Greece 2004 Italy 2005 Cyprus 2005 Malta 2005 France 2004 Ireland 2005 United Kingdom 2005 Switzerland 2005 0 10 20 30 40 50 60 70 80 90 100 Source: WHO Regional Office for Europe 2007a. Notes: CARK: Central Asian republics plus Kazakhstan; CIS: Commonwealth of Independent States; EU: European Union; Eur-B+C: WHO pre-calculated indicator based on data from 26 mainly eastern European countries with different mortality characteristic from Eur-A countries; TFYR Macedonia: The former Yugoslav Republic of Macedonia; Eur-A: WHO precalculated indicator based on data from 27 countries in western, southern, central and northern Europe. 21
Health systems in transition Latvia substantially higher than the 91.3% average for the EU (WHO Regional Office for Europe 2007a). Minorities Statistical data on health status by ethnic origin are not collected in Latvia; therefore, it is not possible to arrive at any conclusion identifying or characterizing any differences in health among minorities. The minorities in Latvia have been residing there for long periods of time and are not localized in one administrative territory, but are scattered throughout the country. Health inequalities and access to health care services A major restriction to access to medical care is low income. The proportion of poor people is still very high in Latvia (as noted in Section 1.3 Economic context) and there is evidence that population health depends in part on ability to pay for health care services. Increasing prices and low incomes limit possibilities for receiving health care services or purchasing medicines (Krastins 2005). According to a survey of 1000 citizens in various regions of Latvia, one third of the respondents were unable to obtain necessary health care services as a result of low incomes (Boronenko 2003). Moreover, the regions with the more serious access problems were also those in which the population suffers from the poorest health, suggesting that there is a close link between health status and access to health care services. Other studies suggest that even larger proportions of the Latvian population may have difficulties with access due to not being able to afford certain services. According to the United Nations Development Programme (UNDP) Latvian Population Development Report, 83.0% of respondents are worried about their ability to cover health care expenses (Kesnere 2005b). A total of 48.2% of respondents who had participated in the survey “Latvian population income level and health care access” (Karaskevica 2003) answered they had refused health care services due to lack of money for patient payment, and 32.9% had worried about final treatment expenses. By comparison, only 18.9% respondents refused health care services due to doubt about medical staff’s competence and experience. Further, 51.6% of respondents do not buy prescribed medications regularly, and 75% of these refer to lack of money as the reason for this. As Fig. 1.3 indicates, the lower the income, the higher the proportion of respondents who worry about lack of money as a constraint to receiving necessary health care services. 22
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5. Physical and human resources 5.1
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6. Provision of services 6.1 Public
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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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