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Reflection of the Director of the NHIF about the health system assessment: some aspects are already being improved
There is a lack of consistency in the funding and organization of health care. This conclusion was reached after a Supreme Audit Institution (SAI) performed for the first time a health system assessment of the period 2010-2018. According to Gintaras Kacevičius, the Director of the National Health Insurance Fund under the Ministry of Health (NHIF), some of the aspects mentioned in the assessment that are related to the compulsory health insurance are already being improved, while others will be started to be addressed in the near future.


A SAI finds in its assessment that the state has entered into commitments under the current regulation that do not match financial possibilities – to pay for 19 groups of individuals insured from the state budget. According to the Director G. Kacevičius, the NHIF has also repeatedly expressed its position that the state should allocate more funds to insure economically inactive population groups, including children and retired individuals. "Currently, the state pays about 31 euro per month to the Compulsory Health Insurance Fund for one person insured from the state budget, while the minimum monthly contribution paid by a self-paying person is 39 euros, and the average contribution of employees working under the employment contract is 90 euros", - says the Director of the NHIF.
The World Health Organization also recommends and draws the attention of states that all residents, regardless of their financial situation, should have access to the necessary health care services. Insufficient funds are also allocated to carry out the four functions delegated by the state - to pay for the organization of blood donation in Lithuania, to implement the national program of immuno-prophylaxis and reimbursement for orthopedic aids, and to ensure emergency medical services. To cover the difference, the funds of the budget of the Compulsory Health Insurance Fund (CHIF) are used to ensure lower future spending on healthcare. For example, the immuno-prophylaxis program helps to prevent infectious diseases the treatment of which would require spending much more money in the future.
It is noted in the assessment report that the funds of the budget of the CHIF are used in the absence of health problems of insured individuals. To address this issue, the NHIF has already initiated and is preparing the necessary documents – the authorities expect to propose in the nearest future improvements to the Law on Health Insurance, which will legitimize the use of the funds of the budget of the CHIF not only for the treatment of diseases but also for their prevention. Such a broader understanding is inherent in modern compulsory health insurance.
According to a SAI, the National Health Insurance Fund sets service prices for health institutions that are not based on objective costs. It is emphasized that basic service prices do not include equipment and buildings depreciation costs of health institutions. At the moment, a special working group has been set up in the Ministry of Health to decide how to transfer medical equipment and buildings to medical institutions that currently belong to the state. This would allow the costs of depreciation of these assets to be included in the basic prices paid by the National Health Insurance Fund, by increasing the latter accordingly.
The assessment of the health care system found that the development of outpatient services is not ensured in Lithuania. However, the data of the NHIF show otherwise - the range of outpatient services is constantly expanded, and more and more services are provided every year in the country's medical institutions. For example, in 2018, 8,8 million of these services [A1] were provided, while in 2018 – 9,7 million. In particular, admission to hospital-emergency room, day in-patient care, day surgical care, monitoring services are growing. Only in recent years has the growth in advice of medical professionals stabilized. Meanwhile, the number of inpatient services is clearly decreasing: in 2012, 657 thousand of these services were provided, and last year – 558 thousand.
In addition, there is a constant priority for funding family medicine: the fees for family medicine services are increased every year, the range of primary outpatient personal health care performance indicators is constantly expanded, and institutions are additionally financially encouraged to implement these indicators. Institutions are currently encouraged for 12 good performance indicators. It is planned that in the next year the share of funds for primary health care will grow even more and will reach 20 percent of total health expenditure.
"The NHIF was and is open to all rational proposals, specific recommendations for improving the compulsory health insurance system - to everything what would allow to better perform a mission of the National Health Insurance Fund, specifically to improve the financial protection of the population in case of illness, to ensure access to health care for the individuals insured with the compulsory health insurance and to promote its quality, to improve the payment to medical institutions for the services they provide", - says G. Kacevičius, the Director of the NHIF.


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Reflection of the Director of the NHIF about the health system assessment: some aspects are already being improved