Policy responses for Latvia - HSRM


Policy responses for Latvia

4. Paying for services

Adequate funding for health is important to manage the excess demands on the health system. This section considers how countries are PAYING FOR COVID-19 SERVICES. Health financing describes how much is spent on health and the distribution of health spending across different service areas. The section also describes who is covered for COVID-19 testing and treatment, whether there are any notable gaps (in population coverage and service coverage), and how much people pay (if at all) for those services out-of-pocket.

4.1 Health financing

Financing mechanisms to tackle second COVID-19 wave

A strategy has been developed to provide financing for medical and personal protective equipment, improving health facilities’ infrastructure, providing financial bonuses for health professionals and improving resilience of public administration during the second wave of COVID-19 which hits the country much stronger than the first wave. The financing strategy comprises funding of a total of EUR 254.27 million for the health and public health package which is allocated as follows:

1) the largest share of the funding (EUR 65.95 million) is intended the strengthen laboratory services and their capacities. The funding aims to provide additional SARS-CoV-2 tests for 8,000 people per day.

2) It is planned to spend EUR 52.6 million personal protective equipment (PPE) to equip medical personnel throughout 2021.
3) EUR 50.2 million are planned to be directed to the improvement of the infrastructure of health facilities in accordance with epidemiological safety measures, in particular separating patient flows, reconstruction of hospitals, as well as construction of new medical buildings and outbuildings.

4) EUR 25.2 million are intended to improve access to health care services.

5) A total of EUR 16.7 million is planned for the recalculation of service payment tariffs and the provision of safety standards in the treatment process within hospitals.

6) EUR 15.5 million are planned to be spent on the creation of a network of COVID-19 vaccination centres.

In addition, on December 8, the government decided to allocate an additional EUR 8 million to set up new beds for COVID-19 patients, to re-purpose existing hospital beds and to provide the necessary additional medical equipment.

Moreover, EUR 32.7 million have been allocated for bonus payments for health professionals working in state and municipal medical institutions with hospitalised COVID-19 patients. The bonus payments which also compensates for overtime work corresponds to 100% of their salary rom 1 November to 31 December. These bonus payments will also be available to employees of admission departments in state and municipal medical facilities, involved in COVID-19 testing and performing COVID-19 patients' home care, employees of the Emergency Medical Service and certain officials and employees of the Center for Disease Prevention and Control. GP practices will also receive additional remuneration.

Financing for health services mitigating COVID-19 related mental health effects

The government allocates EUR 7.11 million to reduce negative effects of the COVID-19 pandemic on mental health. The measures include ambulatory and hospital services, complex psycho-emotional support initiatives for hospital physicians and staff, additional motivation to promote cooperation between family doctors and psychiatrists (e.g. family doctors will be able to refer patients to psychologist or psychotherapist prescribing up to ten consultations), as well as regular monitoring of the psycho-emotional state of society. Services will be available as of spring or mid-2021. The following funding is allocated per service: EUR 1,78 mlllion for specialist consultations (5-10 consultation per patient referred from family doctor); EUR 1,28 millionn for ambulatory services; EUR 323,985 for hospital services; EUR 839,973 to support health workforce in ambulatory care centers; EUR 430,862 to support remote consultations; EUR 671,904 for health care services for children and teenagers in rural regions and EUR 156,156 to set incentives for family doctors to assess their patients’ mental health.

EUR 1,6 million will be allocated for the psycho-emotional support of medical staff and monitoring thereof in 2021. Measures include among others the establishment of a psycho-emotional team in medical institutions and coverage of co-payments for remote mental health consultations.

On March 3rd, The Cabinet of Ministers allocated an additional € 2.6 million to the health sector to provide the necessary measures to limit the incidence and for the treatment of COVID - 19 infections. The additional funding is intended to cover the cost of purchasing the necessary personal protective equipment (including respirators, goggles and waterproof overalls) for family physicians, medical institutions, the Emergency Medical Service and the Center for Disease Prevention and Control.
Financial resources are also allocated to provide laboratory diagnostics (reagents and laboratory equipment), medical equipment (artificial lung ventilation equipment and non-invasive ventilation equipment) and medical treatment for virus infection, and for the Emergency Medical Service to set up a new team. Most of the funds come from the government reserve for contingencies.  The funding is allocated through the usual channels (NHS). 

As per a governement decision on April 9, the health sector will receive an additional € 14 million to finance the three main hospitals (Stradins Clinical University Hospital, Riga East University Hospital and Children's Clinical Hospital) for pandemic response, said the Ministry of Finance. The funds are intended to increase the number of beds, purchase additional equipment and also increase testing capacity if necessary.
As of April 28, the government has allocated EUR 19.7 million to the Ministry of Health to fight the COVID-19 pandemic.

Update 29 June:

The following will be in force until the end of 2020 (Amendments to Cabinet Regulation No. 555 of 28 August 2018 “Procedures for Organization and Payment of Health Care Services” June 9,2020)

-If a patient’s chronic illness worsens, but it is not life threatening and hence is not dealt with by the Emergency service, family doctor's home visits will be covered from state budget