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05-07-2022

Numbers talk: healthcare in Lithuania in 2021

Iliustracija

Last year, Compulsory Health Insurance system was impacted by three major factors: Covid-19 quarantine and two extreme situation announcements – the threat of the coronavirus and massive inflow of foreigners from the Republic of Belarus. Despite the circumstances that complicated the normal course of operations, the National Health Insurance Fund under the Ministry of Health (NHIF) engaged in works, related with the improvement of the service quality and availability, reduction of patient household costs on healthcare, worked to ensure the financial sustainability of the compulsory health insurance fund system, etc.

The expected CHIF revenue plan was exceeded by 4 per cent

In 2021, Compulsory Health Insurance Fund (CHIF) received nearly 2.7 billion Eur of revenue. Since our country’s macroeconomic indices have been favourable for the CHIF revenue collection, the fund's revenue plan was exceeded by 4 percent.

The net costs of the CHIF budget under obligations taken constituted 2.5 billion Eur – the plan was fulfilled to 97 per cent. Just like every year, the major part of the CHIF costs consisted of the funds used to cover personal healthcare services. The same number last year was 1.7 billion Eur.
In recent years, the total amount of invoices received has not exceeded the receivables, and the ratio of credit debt to income remained at the same level as well. This helped ensure a balanced and sustainable CHIF.  

Funds from the reserve used to aid medical institutions

In 2021, the factual CHIF reserve constituted nearly 335 billion Eur, 61 million Eur of which was actually used. Last year, the majority of these funds – 37 million Eur was used to reimburse medical institution costs, incurred due to the increase of the salaries of the staff, working with COVID-19 patients. According to calculations, the total amount, allocated from CHIF to this purpose during the first and second quarantines (2020-2021) was nearly 140 million Eur.

More than 23 million Eur from CHIF reserve last year was allocated to healthcare services with increased price value of a basis point, provided since September. This enabled to increase the salaries of the medical staff. The price value of a basis point increased from 3.8 to 5 per cent. According to statistics, last year, the average salary of all medical staff and physicians increased by 16 per cent, nursing staff – 18 per cent, while the average pay growth in Lithuania was 10 per cent.

Half a million Eur more from the CHIF was allocated for the healthcare services, provided to foreigners that have illegally crossed the Lithuanian border. According to Statistics Lithuania, the number of illegal migrants in Lithuania at the end of 2021 exceeded 4,300. This year, the costs from this reserve were compensated by the European Commission.

Many of the services are still below the pre-pandemic level

2021 saw changes in the procedure of covering inpatient and outpatient personal healthcare services, and inpatient care services related to Covid-19. The Ministry of Health kept adjusting the procedure of the payment or the services in order to ensure the financial stability and service provision at medical institutions.

Just like in 2020, the amount of obligations, assumed by medical institutions, exceeded the amount of services actually provided. The number of outpatient services increased by 12 per cent, while inpatient – by 2 per cent. Thus, the amount of inpatient and outpatient services was higher than the year before last, but lower than in the pre-pandemic 2019.

Last year also showed a notable growth in the number of economically efficient services, including specialised outpatient services. As the range of the services grows, the number of the services provided increases every year, but has not yet reached the pre-pandemic level.

The number of the expensive examinations and treatments, provided in 2021, has outgrown the same index in 2020 by nearly 16 per cent. Thus, the number of these services has not only reached, but also exceeded the level of 2019. Last year, the CHIF-covered service range was increased by adding a new examination – the epidermal growth factor receptor in tumour tissues and body fluids.

Primary outpatient personal healthcare services were allocated more than 19 per cent of the total funds for healthcare services. Moreover, the availability of these services has been increased as well. 2021 also marked the reduction of the number of residents assigned to a single medical psychologist and, taking this into account, the increase of the annual basic cost of primary mental health care for one assigned resident. Several incentives, related to the emergency medical aid, dental care and services, provided to illegal migrants, were introduced too.

Additional funds have been allocated to support the work of two emergency medical assistance teams in municipalities with a decreasing population. The payment for the emergency medical assistance services was adjusted according to the statistical population number of the municipality serviced, which is adjusted according to the actual location of imprisoned convicts and accommodation of illegal migrants. NHIF experts noticed that the number of calls for ambulance in 2020 has decreased, while last year this index has returned to the pre-pandemic level and even exceeded it.

Meanwhile, the number of both inpatient and outpatient services has increased, compared to 2020, but has not reached the level of 2019 yet. 2021 marked the beginning of psychosocial rehabilitation services for patients, recovered from Covid-19. This required 3.8 million Eur.

Smaller patient co-payments for medicine

The funds, allocated for reimbursement of medication and medical aids, from the CHIF keep increasing every year, at the same increasing the average amount allocated for a single prescription of reimbursable medication or medical aids. Since as of July 2020, the co-payments by the most sensitive patient groups have been covered from the state budget, last year, the amount of patient co-payments for medication and medical aids decreased by 4.5 million Eur, compared to the year before. This means, that the amount decreased by as much as 20 per cent.

It also should be noted that 2021 marked the beginning of the reimbursement for 17 new generic medications for migraine, rheumatoid arthritis, ulcerative colitis, unstable angina, oncology and many other conditions.

Very rare condition treatment required nearly 11 million Eur from CHIF. The majority of the funds was allocated to medication for people with particularly rare metabolic conditions, spinal muscular atrophy, Duchenne muscular dystrophy and other very rare oncological diseases.

The list of remunerated medication and medical aids last year was supplemented with a hydraulic urinary incontinence system. Moreover, compared to 2020, last year showed a notable increase in the demand for transcatheter aortic and pulmonary valve implantation, thus, in 2021, CHIF allocated a larger sum – 4 million Eur – for the valve procurement. That is nearly 3 million Eur more than in 2020.

Last year, the number of endoprosthesis surgeries started to increase again. There were more than 6850 primary endoprosthesis surgeries in 2021, while the same number in 2020 was only 5960.

NHIF experts also noticed an annual increase in the number of patients that have the rental costs for artificial lung ventilation and vital function monitoring devices covered from the fund as well.

The year before last showed a significant decrease in both the number of reimbursed orthopaedic technical devices and the patients that have been issued these devices. Meanwhile, last year, this area got back on track and the costs for reimbursed orthopaedic technical devices from the CHIF budget increased by as much as 22.4 per cent. Moreover, as of 2021, the list of reimbursed orthopaedic technical devices included orthodontic appliances prescribed to patients with certain indications.

Leaving queues for dental prosthesis behind

According to NHIF, there are more than 1.4 million residents in Lithuania, who are eligible to services, established in preventive programmes, based on their age range, i.e. they can benefit from free screening for cervical, breast, colon and prostate cancer and cardiovascular diseases. Last year, these programmes were allocated 23.5 million Eur from CHIF funds. The good news is that last year patients became more active in participating at screening programmes and, in many cases, the number of the patients undergoing their timely check-ups exceeded the pre-pandemic level.

Since 2021, upon changes in the procedure of service provision and payments, as well as increased funding helped to eliminate queues for dental prosthesis. Therefore, patients can receive dental prosthesis services nearly immediately. Last year also introduced a new procedure –patients that have been provided with dental prosthesis services and treatment for oncological diseases of the mouth, face or jaw, do not have to wait for another 3 years to use dental prosthesis services, reimbursed from CHIF.

In 2021, CHIF reports were approved by the Compulsory Health Insurance Council. The documents will also be discussed by the Government and the Seimas.

The CHIF reports for 2021 are available here.

(Piktochart pict.)

The NHIF invites you:

Your questions are welcome by email[email protected]or phone: local (8 5) 232 2222, international +370 5 232 222

Last updated: 22-02-2023

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