The basic conditions for payment of health care services from the CHIF are:
- Emergency medical services are provided free of charge to all residents. The extent of emergency medical services are approved by the Minister of Health in 2004.
- Secondary and tertiary health care services are provided to the insured by compulsory health insurance.
- In order to get healthcare services patient should always turn to his family practitioner first of all. If family practitioner decides that it is necessary, then he will give a referral to a specialist and that consultation will be covered by CHIF.
- The admission to the hospital takes place with the referral issued by a family practitioner or specialist. Only in the case of an emergency patient can go directly to the hospital.
- The patient has the right to choose a primary health care facility and doctor, as well as secondary or tertiary care facility and physician.
- If patients, entitled to free health care services, on their own initiative choose the more expensive services, materials or procedures for these services, they cover difference of the actual price and free services, materials or procedures base price themselves.
According to Art. 13 of the Law on Healthcare Institutions, the Ministry of Health of Republic of Lithuania establishes the prices for services provided by institutions belonging to the Lithuanian National Health System. The prices for services provided by institutions, which do not belong to the Lithuanian National Health System, are established by their management bodies or owners in accordance with the procedure established by the laws of these institutions.
The costs of outpatient services:
The costs of healthcare services
The costs of day care services
DRG-based costs of active in-patient services
DRG-based costs of day surgery services
The costs of other in-patient services
The reference prices paid from the budget of the Compulsory Health Insurance Fund are approved in points. From the 1 January 2014 the value of 1 point is:
- for primary healthcare services – 0,97 LTL;
- for out-patient consultations – 0,93 LTL;
- for in-patient healthcare services – 0,89 LTL;
- for expensive examinations and procedures – 0,93 Lt,
- for medical rehabilitation and sanatorium treatment – 0,91 Lt;
- for dental prosthetic services – 0,89 Lt.
The real cost of the service is obtained by multiplying the price in points by the point value.
Since 1 January 2012 the diagnosis–related groups (DRG) based reimbursement system has been used in Lithuania. Clinically and economically similar services are classified into groups. Different reference prices are approved for each group. After assessment of the patient's diagnosis, interventions carried out during the treatment episode and any complications, the healthcare service is assigned to a DRG group. The price paid to hospitals depends on the DRG group to which the particular service has been assigned. The costs of expensive examinations and procedures performed during the episode of the active in-patient treatment are included in the total cost of healthcare service and are not reimbursed separately. The actual cost of the service increases if expensive blood components, medical aids or chemotherapy pharmaceuticals are used.