Healthcare reform changes service coverage


2022 06 17


The structural reform of healthcare institutions is expected to include specific changes in the procedure of payment for the services. The changes in funding are expected to enable an increase in the availability of healthcare services to patients and improve the working conditions of the medical staff.

During the reform of the healthcare network, the Territorial Health Insurance Fund (THIF) will sign an agreement regarding the coverage of healthcare services in cases, when all healthcare services in a municipality are provided by a single medical institution (structural healthcare centre). Meanwhile, if the treatment institutions in a municipality have signed mutual cooperation agreements regarding the provision of basic services (functional or structural-functional centres), the THIF will enter into agreements with the municipality’s medical institutions, which can provide services according to the law.

‘During the healthcare network reform, each year will include additional funding to increase the general physician’s team. This will enable to facilitate the burden on the general physicians, since certain of their functions will be taken over by other members of the team. Finally, these changes will benefit the residents, who will gain an access to high-quality and easily available health care services’, said Arūnas Dulkys, Minister of Health.

According to him, the preliminary demand for the CHIF funds, needed for this purpose, has already been calculated, being approximately 10 million Eur per year. The GP team will be expanded by including more nurses and social workers that can take over the management functions, also obstetricians, nurse assistants, physical therapists, and other health care specialists.

Currently, health care institutions are submitting information on the number of specialists, working in their GP teams and their work load. Upon evaluating the information received, the Health Insurance Fund will start consistently increasing the coverage of primary outpatient healthcare as of the following year, based on the increasing GP team of each specific medical institution.

The funding of a full GP team is expected to be increased every year with hopes to have the GP teams fully formed by 2030 the latest.

The Ministry of Health and the National Health Insurance Fund (NHIF) also have a clear vision of the funding of the examinations, prescribed by a GP, applied in the course of the reform. The preparatory works, currently taking place, include the development of a classification of examinations and adaptation of the information system. The results of this study will provide a picture of the examinations, conducted by general physicians, enabling to calculate the demand for funding for the examinations, needed by different age groups. Based on the data, provided by treatment institutions, it is expected to have the final calculations and the legal and financial base for the implementation of the examination fund already next year.

It is also planned to conduct annual reviews and updates of the GP lists of incentive bonuses and good work results, starting as of next year, in order to make sure that the funding allocated complies with the current needs and actually promotes the increase in the quality and accessibility of the healthcare, provided to the patients.

There are public concerns that, with different elements of the healthcare system working in a single centre, the reform might reduce the role of a general physician. Experts are convinced that healthcare centre should not only not reduce the role of a general physician, but strengthen it, improving cooperation with the expert physicians of each centre. In turn, the Ministry of Health and its subordinate institutions will improve the payment system and thus move towards a decrease of excess hospitalisation, using these funds for the improvement of specialised outpatient service calendar, the quality of the priority services, and increasing the capacity.

For this purpose, the payment of medical specialist consultations will be improved in a way that the payment depends on the content, rather than the level of the service. This means that the payment will depend on the scope and costs of the examination and treatment, conducted during the consultation.

‘The aim of our health centre funding model is to decrease the number of services that do not create added value, offering the patients specialised and high-quality services only when they truly need them. We must develop an efficient system, eliminating certain unneeded and bureaucratic requirements for medical expert consultations.’ says Tatjana Golubajeva, Deputy Director of the NHIF.

The reform will also include an increase in the range of day inpatient services and a review of the emergency medical aid coverage, which will be based on an approved price list. In small municipalities, where the number of emergency medical aid services is small, they will be subject to a mixed payment model, where the payment for the services rendered will be coordinated with the constant portion of the funds, allocated to ensure the service provision. A similar payment model should be applied in cases, when healthcare centres offer therapeutic inpatient services.

Moreover, there is a plan to create new outpatient integrated services and their payment procedure. The key idea behind these services is to provide a patient with the needed examinations and treatment procedures in a single day thus reducing the number of excess visits.

The prices for inpatient nursing and long-term care services will be increased according to the updated requirements for these services already this year. There is also a plan for the development of care services at home, i.e. there will be more outpatient care services for patients with higher needs.

Preparations for the healthcare network reform will also include adjustments of the service coverage procedure. The funds are planned to be distributed among medical institutions in a way to enable the residents to choose and receive the main and most common outpatient or day services within the territory of their municipality. This would enable to fulfil one of the major goals of the reform – to ensure that patients have an easy access to high quality services as close to their place of residence as possible.

The adoption of the package of the law reform by the Seimas will be followed by the formation of working groups that will have to adjust the payment procedures.

Information from the Press Office of NHIF and the Ministry of Health

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