Skip to main content
18-07-2023

Lithuanian healthcare in 2022: main facts and figures

Iliustracija

2022 was the third year in which the compulsory health insurance system operated in the context of several ongoing or new crises. Last year, the COVID-19 emergency ended on 1 May, the mass influx of migrants from the Republic of Belarus that started in July 2021 continued, and the emergency due to the Russian Federation's military action on the territory of Ukraine started on 24 February. The Compulsory Health Insurance Fund (CHIF) has been burdened with additional financial pressures, but even in such a challenging situation, the budget has managed to remain balanced and to ensure the financial sustainability of the compulsory insurance system. The CHIF revenue plan was exceeded by 6%.

Last year, the overall macroeconomic environment in the country was favourable for the collection of CHIF income, as both the average monthly wage (AMW) and the minimum monthly wage (MMW) increased, while the unemployment rate declined. In this context, CHI contributions grew and in 2022 the CHIF had a surplus of EUR 172.5 million, which exceeded the Fund's revenue plan by 6%.  

CHIF’s credit indebtedness did not grow and CHIF’s net expenditure under commitments amounted to EUR 2.8 billion, 97% of the expenditure plan.

Financial performance of healthcare institutions improves, wages increase

An important factor in last year’s decisions was the price developments already observed in the second half of 2021. In order to at least partially compensate for the rising costs of energy resources and catering for health facilities and to allow for an increase in the salaries of their staff, the basic price points for health services were increased 3 times last year. In 2022, the CHIF reserve had EUR 534 million available, of which EUR 103 million was used. Most of it (EUR 43.3 million) was earmarked for additional payments to medical institutions for services rendered to patients due to COVID-19; EUR 25.7 million to reduce the arrears of reimbursable medicine and reimbursed medical aids (MA); EUR 14 million to cover the costs of Lithuanians treated abroad, etc. 

In 2021, the financial result of the institutions calculated from the CHIF funds amounted to EUR - 12 million and was negative for most of the institutions. In 2022, the financial result was more than 6 times better and the number of treatment facilities that ended the year with a positive financial result also increased.   

Wage rates in healthcare institutions have also increased. Although from 2022 onwards the so-called covid bonuses were no longer paid from the CHIF budget, the salary increases in the medical institutions of Vytautas Magnus University were nonetheless higher. 

For example, the cost of one post for doctors at Vytautas Magnus University was EUR 3 649 in January-October last year, while in November-December it rose by 13% to EUR 4 137, and for nurses at Vytautas Magnus University it rose by 16% (from EUR 1 787 to EUR 2 076). 

Significant assistance to migrants, Ukrainian citizens and coronavirus patients

According to the data of the Migration Department, about 4.5 thousand irregular migrants had reached Lithuania by June this year. Back in 2021, the Health Insurance Fund was obliged to use the CHIF reserve to pay for their healthcare costs, provided that the reserve would be restored by the state budget after the end of the emergency situation. Almost EUR 1.5 million has been restored to the reserve, most of it (90%) from the European Commission and the rest (10%) from the state budget.

People coming from Ukraine, the majority of whom are Ukrainian citizens, have also had to pay higher healthcare costs from CHIF. They have been receiving and paying for healthcare in Lithuania since March 2022. Last year, EUR 10 million from the CHIF was spent on this. 

During the 2020-2022 emergency, the CHIF also covered the treatment of uninsured persons for COVID-19 disease, as decided by the Chief of emergency operations, but at the end of the emergency, the full cost of the CHIF - EUR 888,000 - was reimbursed by the State budget. This marked a return to normal payment conditions for active treatment services for institutions treating patients with COVID-19 last year.

Increase in total number of services

In 2022, spending on primary health care continued to increase. One of the priority groups of personal healthcare services, primary outpatient personal healthcare, accounted for more than 18% of total personal healthcare spending, that is, EUR 364 million. 4 new incentive bonuses were introduced for health facilities to improve access to some services: 

  • for a new service - screening for hepatitis C virus infection;
  • for the vaccination of persons against COVID-19; 
  • for carrying out laboratory tests on pregnant foreign women; 
  • for performing the natriuretic peptide test, which is essential for the diagnosis of heart failure.  

The number of both outpatient and inpatient services increased last year, although it did not reach the level of 2019. The number of outpatient services (outpatient specialised, day hospital, day surgery, outpatient surgery, emergency, observation) increased by 11%, while the number of inpatient services (active and long-term treatment) increased by 12% compared to 2021. 

The number of ambulance calls has returned to pre-pandemic levels and even exceeded them, with almost EUR 91 million of CHIF funds spent on the service's work. In 2019, the service’s staff responded to 651,000 calls, compared to 663,500 last year.  

The number of expensive tests and procedures has also increased rapidly. Last year, 674,000 of them were provided at a cost of EUR 96 million, which is EUR 11 million more than the year before. Two new tests were also added to the list of high-cost tests and procedures in 2022: the Prosigna Breast Cancer Prognostic Gene Signature Assay, and the gamma interferon isolation test for assessing the response of blood lymphocytes to Mycobacterium tuberculosis antigen stimulation for the diagnosis of paediatric tuberculosis. 

To improve access to nursing care, the CHIF has been increasing the amount of money it pays for nursing care each year. In 2022, the CHIF allocated EUR 129.4 million for nursing services, an increase of almost 23% compared to 2021. 

Last year the requirements for the provision of palliative care and nursing care services were overhauled and new prices for these services were set. Access to outpatient palliative care services was also improved. In 2022, the outpatient home care services team was expanded with the addition of a physiotherapist and a nurse assistant, and the setting of fees for their services. In addition, a questionnaire has been validated on the basis of which outpatient home care services can be provided. 

Last year marked important changes in rehabilitation and rehabilitation services. Inpatient rehabilitation services have been prioritised - after heart attacks, strokes, serious injuries, arthroplasty or oncological operations. The new payment arrangements allow for the possibility to pay for all over-contracted services on a monthly basis.  

In 2022, the provision of medical rehabilitation services (number of bed days) reached pre-pandemic levels, with 1.9 million services provided to more than 308,000 people at a cost of EUR 111 million. 

Significantly more is spent on reimbursed medicines and MA

In 2022, about 1.2 million patients in Lithuania, which is about 43% of the total Lithuanian population, were using reimbursed medicines and MAs. Of these, those aged over 60 years who used reimbursed medicines and MAs accounted for about 83% of the total Lithuanian population of that age. Due to the ageing population and the increasing provision of outpatient healthcare services, the use of reimbursable medicines and MAs is increasing. As a result, CHIF spending on reimbursable medicines and MA (excluding premiums) increased significantly last year to EUR 458 million (EUR 390.5 million in 2021) and total premiums amounted to EUR 39 million last year, EUR 5.7 million higher than in 2021. 

The most vulnerable groups, such as patients aged 75 and over, low-income earners over 65 and disabled people, were given access to reimbursed medicines and MAs without paying a patient premium. Last year, the number of these people amounted to 341,000 and the cost of the premiums amounted to EUR 19 million. 

Last year, more than 2 200 brand-name medicines were reimbursed in Lithuania, and reimbursement of 16 generic medicines for multiple sclerosis, mental and behavioural disorders due to opioid use, ulcerative colitis, stomach, breast and prostate diseases, and many other conditions was launched. 

Last year also marked an increase in the number of MAs already reimbursed, with the introduction of prescription reimbursement for the purchase of tracheoesophageal voice prosthesis devices for cancer patients, and an increase in the number of reimbursable plates for stoma patients and in the number of therapeutic dressings for various types of wounds. Significant attention was paid to meeting the need for new blood glucose monitoring systems for patients with type 1 diabetes. Reimbursement of continuous glucose monitoring systems was introduced for these individuals. Each year, CHIF reimbursement of more and more care products increases access to care and reduces household expenditure on these products. 

Advanced measures have started to be reimbursed 

Spending on centrally reimbursed medicines and MAs remained similar in 2021 and 2022, at around EUR 54 million. In 2022, 2 new MAs were added to the list of centrally reimbursed medicines and MAs: catheters for canaloplasty, which are used to treat eye diseases, and renal artery denervation catheters, which are implanted in cases where blood pressure cannot be controlled by other means. 

It is particularly important to note that in 2022, the number of endoprosthetic surgeries has returned to pre-pandemic levels and even slightly exceeded them. In 2019, 8,632 operations were carried out, compared to 8,883 last year. 

The number of patients receiving reimbursement for treatment of very rare conditions and for treatment in unforeseen cases also increased last year. The National Health Insurance Fund issued 532 guarantee letters in response to requests from medical institutions to reimburse the costs of treatment for 318 patients (98 of them new patients) diagnosed with very rare conditions. For this purpose, EUR 13.2 million have been allocated in 2022. In contrast, the previous year, 270 patients were reimbursed for such treatment at a cost of EUR 10.8 million. 

The largest share of funding for rare conditions goes to medicines for ultra-rare metabolic diseases, spinal muscular atrophy, Duchenne muscular dystrophy and very rare oncological diseases. 

Every year, more and more rental medical equipment is reimbursed. Since April last year, insulin pump rentals have been reimbursed for all people with type 1 diabetes, regardless of age. In addition, the conditions for prescribing opioid analgesic infusion devices have been simplified.

The number of orthopaedic equipment and medical devices issued last year was also higher than in 2021, with more than 88 000 people receiving them. The cost of reimbursing these devices amounted to EUR 17.2 million. 

Last year, eyeglass lenses started to be reimbursed as a medical measure, and two hearing aids are prescribed for insured persons over 24 years of age, while children are reimbursed for technologically more advanced, newer generation hearing aids. In addition, a new generation of knee replacements with a microprocessor-controlled knee joint has been added to the list of orthopaedic technical devices.

Increase in the number of people screened under preventive programmes

The largest amount spent on health programmes and other health insurance costs last year was EUR 50.8 million for prosthetic dental services. CHIF expenditure per person receiving prosthetic services also increased (from EUR 569 to EUR 628), as did the number of people receiving these services, from 65 000 to 81 000. 

A further EUR 30.8 million was spent on five preventive programmes. It is estimated that there are currently more than 1.4 million people in Lithuania who have access to free services under the prevention programmes, namely free screening for cervical, breast, colorectal and prostate cancer and cardiovascular diseases. 

Preventing the disease in time preserves health and working capacity, avoids the need to seek further treatment from specialists, saves doctors' time and avoids higher treatment costs. According to the data of the National Health Insurance Fund, the number of people who received services under almost all preventive programmes was higher last year compared to 2021, ranging from 43% to 63%.  

The 2022 CHIF Accounts have been approved by the Compulsory Health Insurance Board. The documents will also be discussed by the Government and Seimas. 

(Pexels photo)

The NHIF invites you:

Last updated: 09-08-2023

Related news:

Health budget in 2025: what benefits did we receive?

The right to be informed: what is important to know about reimbursable healthcare

Tens of millions of euros for residents’ health: for whom and how are medication co-payments covered?

Study reveals: a family doctor’s advice determines the decision to get checked

Unexpected ailments during the holidays: where to turn and what to know