Presentation by V. Keris, Dr. habil. med., Chairman, Trade Union of Health and Social Care Employees of Latvia (LVSADA) during the conference on "The impact of the crisis on employment in the Baltic states" in Vilnius (19 Nov 2010)

1. Health Care in Latvia:
the Chronicle of Crisis
V. Keris, Dr. habil. med.
Chairman,
Trade Union of Health and Social Care Employees
of Latvia (LVSADA)
1Vilnius, 19.11.2010

2. Content
 Situation in health
care before the
crisis (2006 –
2008)
 Consequences of
crisis
(2009 – 2010)
 Conclusions
2Vilnius, 19.11.2010

3. Initiative of World Health Organisation:
Health Workers Save Lives! (2006)
 The decade
goal in all
countries
is to build high-
performirng
workforces for
national health
systems to
respond to
current and
emerging
challenges
(WHO. The World Health
Report 2006)
Vilnius, 19.11.2010 3
Proportion of health workers per population
Probabilityofsurvival
Low High
Low
High
Maternal Survival
Child Survival
Infant Survival

4. Human Resources: 2008*
 Doctors (/100 000 pop.)
Latvia – 311
(2009. – 272)
EU – 324
Estonia - 335
Lithuania - 370
 Nurses (/100 000 pop.)
Latvia – 534
(2009. – 507)
EU – 775
Estonia – 640
Lithuania - 711
Vilnius, 19.11.2010 4
In year 2008, Latvian health care
needed 300 doctors and 5500 nurses,
when compared to average EU figures
*sources: www.who.int; Ministry of Health, Republic of Latvia (MH)

5. Maternal Deaths*
(per 100 000 live births)
0
5
10
15
20
25
30
2004 2005 2006 2007 2008
EU
Latvia
Vilnius, 19.11.2010 5
*source: www.who.int

6. Health Care in Latvia and EU: 2008*
Gov.
expend.,
as % of
GDP
Crude
death r.,
per 1000
pop.
Latvia 3.9 13.7
Estonia
Lithuania
EU 12
4.6
4.5
4.7
12.4
13.1
11.1
EU 6.9 9.6
 The proportion of
governmental expenditure
is inversely associated
with number of lives lost,
when population of Latvia
(2,28 mlj.) is compared to
similar size of pop. in EU
12 and EU:
(13.7–11.1)x2280= 5 928
(13.7–9.6)x2280= 9 348
Vilnius, 19.11.2010 6
*source: www.who.int

7. A Steady, Inverse Association...
Governmental
expenditure (% of GDP)*
Crude death rate
(per 1000 pop.)**
0
10
20
30
40
50
2005 2006 2007 2008
EU
EU 12
Latvia
Vilnius, 19.11.2010
*source: EUROSTAT
12
**source: www.who.int
0
2
4
6
8
10
12
14
16
2005 2006 2007 2008
EU
EU 12
Latvia

8. Emerging Health Care Problems in Latvia
Already Recognised: 2008
 Critically high morbidity when compared
to average figures of EU
 The highest mortality in EU
 About 32% of working physicians are in
the age of retirement or closely related
to; only 11,5% of physicians are < 35 y
(Government’s Order Nr. 82, 20.02.2008)
Vilnius, 19.11.2010 8

9. EU Health Initiative: 2007 - 2008
 Decision No.
1350/2007/EC of the
European Parliament and
of the Council
establishing
2nd programme of
Community action in the
field of health (2008 –
2013). Aims: 1. (..)
contribute to increased
solidarity and prosperity
in the EU by protecting
and promoting human
health and safety and
improving public health
 Green Paper on the
European Workforce for
Health [COM(2008)
725]: ensuring
better working
conditions,
increasing staff
motivation
9Vilnius, 19.11.2010

10. Consequences of Crisis (1): Social Dialogue
National Tripartite
Cooperation Council’s
reccommendations
Government’s
response
 15.04.2009: develop
human resources for
health care
 12.08.2009 and
01.04.2010: develop
human resources for
health care; increase
governmental
expenditure on health
care
 Cuts expenditure on
health care
 Cuts remuneration
of medical staff
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Prime Minister since
March, 2009:
Valdis Dombrovskis

11. Governmental Expenditure on Health Care
in Latvia*
Vilnius, 19.11.2010 11
Year LVL, mlj. % %, adj. to
prices
% of GDP
2008 577 100.0 100.0 3.6
2010 459 79.6 73.1 3.5**
1 LVL = 0.7028 EUR
**according to GDP forecast for Latvia issued by IMF
*sources: www.csb.gov.lv; MH

12. Gross Remuneration in Latvia, LVL*(1 LVL = 0.7028 EUR)
Year Average Doctors
(% of average)
Nurses
(% of average)
2005 246 364 (148) 211 (86)
2008 479 654 (137) 392 (82)
2010** 437 524 (120) 314 (72)
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**January - June
*sources: www.csb.gov.lv; Government’s Regulations
2010/2008: -8.8% 2010/2008: -19.9%

13. Consequences of Crisis (2): Structural Reform
of Health Care*
Acute care hospitals
(/100 000 pop.)
Hospital beds
(/100 000 pop.)
 2010: 0,9
 2008: 2,9
(Estonia – 2,8;
Lithuania – 2,5;
Netherlands – 0,6)
 2010: 558
 2008: 746
(Estonia – 571;
Lithuania – 683;
EU – 531;
EU 12 - 667)
Vilnius, 19.11.2010 13
*sources: www.who.int; MH

14. Relative Risk of Case Fatality and Number of Acute
Care Patients, 2010* / 2009, (%)**
0
5
10
15
20
25
30
35
40
Rural hospitals Average University
hospitals
Patients
Case fatality
14Vilnius, 19.11.2010
+ 800 potentially
avoidable deaths
*January - June
Medical staff:
-14.8%
**Sources: Questionnaire of LVSADA; MH

15. Conclusions
 Government of Latvia ignores
reccommendations of social partners
 Government’s policy is in contradiction
with health initiatives of WHO and EU
 Health is not the sector to be reduced
during the crisis
15Vilnius, 19.11.2010

16. Comment
 Armin Fidler, Chief Advisor to the World
Bank on health issues: “Those who allow
the crises to reduce the standard of
healthcare are getting into a long-term
problem with potentially catastrophic
results for the social situation.”
12th European Health
Forum Gastein, Austria
Source: European Hospital, Vol. 18, Issue 5/09
16Vilnius, 19.11.2010

17. Thank You for Attention!
17Vilnius, 19.11.2010