The health sector needs an additional 826 million euros next year, the Ministry of Health has estimated. Doctors say the needs are many and it is high time to solve systemic problems.
There is already a deficit in the payment of reimbursed medications, the salaries of the average medical staff lag far behind the average salary in the country, and the shortage of nurses is becoming increasingly noticeable.
Of the funding needed next year, the lion's share is needed specifically to improve the accessibility and quality of services – 406 million euros, which is 49% of the required amount, and 135 million euros to improve the system of reimbursed medicines and materials.
236 million euros would be needed to increase the salaries of medical professionals and other employees. This would allow medical professionals to raise their salaries by 24%, and other healthcare employees by 120 euros.
This issue is considered a priority by the head of the Latvian Association of Rural Family Physicians, MP Līga Kozlovska (Union of Greens and Farmers): "The average salary of Latvian doctors, with the exception of some super-professional specialties that everyone always talks about, is below the average national salary. And therefore, the Association of Rural and Family Physicians is also demanding an increase in these salaries by at least 25.4%, especially emphasizing that this is necessary for our physician assistants, nurses and support staff."
But several promises have still not been fulfilled. Kozlovska said, with medical staff already stretched to the limit, especially in the regions where coverage for healthcare is more sparse.
Alise Nicmane-Aišpure, president of the Latvian Association of Family Physicians, also called on politicians to strengthen the position of medical staff - nurses, physician assistants, and midwives.
She said: "If we have such a huge shortage, then there can be no other way in healthcare, then doctors do the work of nurses or paramedics. And from the state's point of view, this will always be more expensive than if we provide paramedics in sufficient numbers or at least in a somewhat sufficient number. We have wonderful surgeons with very high abilities who operate, but this training work is extremely important. And the state, in my opinion, should think and act in such a way that paramedics would be interested in working and seeing themselves in our system in the long term, where the issue of remuneration is also not unimportant."
Four nurses per 1,000 inhabitants
The country currently has a shortage of nurses – according to the Ministry of Health, there are four nurses per thousand inhabitants, while in Estonia there are almost seven, in Lithuania there are almost eight, and on average in the European Union there are nine. And it is precisely the low salary that prevents this problem from being solved.
While doctors' salaries have increased by 10.6% over the past 10 years, nurses' salaries have increased by 6.5%, but this has not kept pace with the average salary increase in the country, which has been 31%. Most dramatically, the minimum wage for support staff is still around 800 euros. At the same time, overall inflation over the past five years has been 12.5%.
The lack of money in the health sector has been observed for years, and this is nothing new – several associations point to this. Uldis Hļevickis, a member of the board of the Latvian Health and Economics Association, called on the new government to change its approach to creating the healthcare budget. This especially applies to reimbursed medicines, where until now the main thing was price or cost-effectiveness. Such a principle worked well in the past, but not now.
Hļevičkis said: "We need to change the approach to how this is done. And what's more important is that when decisions are made to include or not include medications [in the list of reimbursed medications], we only look at the impact on the list of reimbursed medications. A budget has been allocated, we know about it - approximately under 300 million per year, but the medication no longer only affects the budget for reimbursed medications, hospitalizations are reduced, other social benefits are reduced, complications and so on, but we also do not have a mechanism for how these funds are redistributed."
There is already a deficit of 35 million euros in reimbursed medications this year.
Deputy State Secretary of the Ministry of Health Boriss Kņigins said that he will not speculate on the amounts that could be allocated next year or not, because the state budget is still being formed. However, it is already clear that the demand for health services is growing, and it is growing. The population is ageing, the number of patients with chronic diseases is increasing, and therefore the need for health care services and, accordingly, money will only increase in the future.
Economist Guntars Vītols, who heads the working group for next year's budget at the Ministry of Finance, said that health is a priority for society, but the decisions made so far in the field of health are without financial coverage. Therefore, the big question will be where to find the missing money.
Vītols said: "And then the big question will be – will we be able to streamline, find funds that are perhaps not being used so efficiently, so that at least in some way this money can be allocated to this priority."
He did not reveal specific steps yet, as the budget is still being developed.
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