Health Insurance Fund: when the most important thing is not the number of tests, but the decisions that are best for the patient’s health
Residents of the country visit their family doctor more than 15 million times a year – on average, around 5 visits per person. During these appointments, when there are medical indications or as part of preventive care, the family doctor or other members of the medical team may prescribe diagnostic tests covered by the Compulsory Health Insurance Fund. The doctor decides individually in each case which tests are needed – whether to establish or clarify a diagnosis, monitor the course of an illness, assess the effectiveness of treatment, or adjust it.
What tests can be prescribed
“Tests are an integral part of diagnostics; however, the most important thing is a comprehensive assessment of the patient’s health condition and an individual approach to each person. The best test is the one that is prescribed at the right time and helps make a decision regarding the patient’s health. The role of a family doctor is not to perform as many tests as possible, but to select those that will provide the most useful information in a particular case,” says Alma Astafjeva, a family doctor and chairperson of the Lithuanian Family Doctors’ Professional Union.
Tests may be prescribed for preventive purposes (a complete blood count, glucose, urine analysis, and lipid profile), as well as under preventive programmes that vary depending on the patient’s sex, age, or specific indications. It is very important to understand that tests are not performed at the patient’s request, but only based on a doctor’s decision.
The range of tests that can be prescribed by a family doctor is broad, and this year the possibilities for performing them have expanded further. General and biochemical blood tests, urine tests, and some stool tests (for example, a coprogram and an enterobiasis test) are carried out, as well as tests for inflammation markers and thyroid function. If necessary, a glucose tolerance test and an electrocardiogram may also be performed.
Before planned surgeries or procedures, tests to assess blood clotting, determine blood type, and establish the Rh factor may be prescribed. When needed, various microbiological cultures, a tuberculin test (for children), tests for viral hepatitis B (for pregnant women) and hepatitis C (under screening programmes), as well as infection diagnostic tests (for example, for influenza, COVID, respiratory syncytial virus, and group A streptococcus) are also performed.
Some tests may also be prescribed by other members of the healthcare team, for example, nurses may order laboratory tests within their scope of competence, and midwives may prescribe mandatory tests for pregnant women.
Diagnosis and monitoring of chronic diseases
According to Diana Prochorova, Chief Specialist of the Service Reimbursement Division at the National Health Insurance Fund (NHIF), certain tests are prescribed by family doctors to assess or monitor specific conditions. These tests are not performed for all patients; they are prescribed only when particular diseases are present or certain conditions are suspected.
For example, people with diabetes undergo a glycated haemoglobin (HbA1c) test, while patients receiving anticoagulant treatment have their blood clotting indicator INR monitored.
For patients with osteoporosis who are starting reimbursed treatment, a vitamin D test may be performed. For the diagnosis and monitoring of anaemia, tests for vitamin B12, vitamin B9 (folic acid), or iron stores (ferritin) may be prescribed. When heart failure is suspected, and since the beginning of this year also for patients diagnosed with heart failure, a natriuretic peptide test is prescribed.
Tests help identify changes earlier
The NHIF representative explains that tests prescribed by a family doctor help assess the body’s condition and often allow healthcare decisions to be made without the need for complex procedures. Tests are performed to the extent necessary to assess the patient’s health condition and the effectiveness of treatment, as well as to start or adjust treatment in a timely manner.
“Quite often, this helps prevent a worsening of the disease or hospitalisation. In many cases, patients do not need to consult specialist doctors just because of tests. If a required test exceeds the family doctor’s competence, the doctor can issue a referral for a consultation with a specialist,” says D. Prochorova.
Preventive and screening examinations
When carrying out preventive health checks, a family doctor and their team also perform simple but important assessments: measuring blood pressure, height, and weight, evaluating vision and hearing, and examining the skin, mucous membranes, lymph nodes, oral cavity, and other areas. The frequency of these checks depends on a person’s age and health condition, and some of them may also be performed by a nurse.
Certain tests are provided free of charge at set intervals as part of preventive care for children, school students, and people undergoing preventive screening for non-communicable diseases, as well as for those receiving long-term monitoring after a serious illness or while living with one.
Patients who visit their family doctor may also be offered the opportunity to participate in disease prevention programmes available to them. These programmes include tests that help identify the risk of cardiovascular or oncological diseases, such as mammography, prostate-specific antigen (PSA) testing, faecal occult blood testing, or cervical screening tests.
Primary healthcare facilities employ a whole team of professionals – not only family doctors, but also nurses, midwives, lifestyle medicine specialists, social workers, physiotherapists, case managers, and administrators. Team-based care enables patients to receive assistance more quickly, devote greater attention to disease prevention, and promote a healthy lifestyle.
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