This presentation was made by Kristina Garuoliene, Lithuania, at the 3rd Health Systems Joint Network meeting for Central, Eastern and South-eastern European Countries held in Vilnius, Lithuania, on 25-26 April 2019

1. Overview of Health Financing and
Budgeting Practices for Health in
Lithuania
Kristina Garuolienė
Viceminister of Health

2. Main Indicators of Health Financing
in Lithuania, 2017
2

3. Compulsory Health Insurance Fund Budget,
in billion EUR, 1997–2018
3
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
2018
plan
2019
progn
osis
Fact* 0,38 0,56 0,53 0,53 0,54 0,56 0,61 0,69 0,84 0,99 1,16 1,33 1,29 1,36 1,39 1,31 1,32 1,38 1,47 1,56 1,72 1,86 2,29
0,0
0,5
1,0
1,5
2,0
2,5
EURbillion
* Reserve and cash balance are included

4. Dynamics of CHIF Budget Revenue
4
0
500
1 000
1 500
2 000
2 500
Balance at the the beginning of the year (operating cash and reserve), EUR million
Other income (including State budget allocations), EUR million
Contributions paid by State budget, EUR million
Contributions paid by other insurers and the insured persons, EUR million
EURmillion

5. Comparison of Public and Private
Expenditure on Health in 2017
5
Source: OECD
Health Statistics
2018
•Data about LT -
from the
Department of
Statistics

6. Structure and Dynamics of CHIF Expenditure
6
0
500 000
1 000 000
1 500 000
2 000 000
2 500 000
ThousandEUR
Other expenditure
Administrative cost
Health programmes and other expenditure
Orthopaedic devices
Rehabilitation services
Medicines and medical aids
Healthcare services

7. Funding of Primary Healthcare Services
(2018)
7
163.081.000.EU
R; 72,52 %
11,69 %
8,82%
6,97%
61.791.800
EUR;
27,48 %
Capitation fee Incentive services (FFS)
Performance indicators (P4P) Aditional capitation fee
FFS:
• Regular care of pregnant
women
• Home care of disabled
• Early diagnosis of
malignant tumours
• Children vaccination
etc.
Groups of indicators for P4P :
• Care coverage indicators
• Performance indicators of
cancer screening
programmes
• Indicators for measurement
of the preventive activities
• Avoidable hospitalisations
of patients with chronic and
mental diseases

8. The cost of healthcare services are covered on the basis of contracts
between THIFs and individual healthcare services providers
Contracts include volume ceilings for different types of services
Special rules for reimbursement of additionally provided services
(exceeding contractual amount)
Basic Principles of the Payment for Healthcare
Services
8

9. Volume of Actually Provided Healthcare Services
Paid from the CHIF Budget in 2016 – 2018
9
0
500
1 000
1 500
2 000
2 500
3 000
3 500
4 000
4 500
5 000
5 500
6 000
6 500
7 000
7 500
8 000
8 500
Specialised
outpatient
services
Emergency
sertvices
provided in the
Admission
department
Day care
services
Outpatient
surgery services
Day surgery
services
Observation
services
In-patient
services
2016 8 463,1 159,6 733,5 38,9 107,3 128,4 591,4
2017 8 317,7 279,8 777,4 43,4 112,4 136,3 567,2
2018 8 230,4 330,8 793,5 46,8 113,7 145,3 557,9
Numberofservices,thousand
• Specialized outpatient services: II, III level consultations, long-term patient
monitoring services, preventive services, neonatal screening services and
additionally paid services

10. Comparison of CHIF Resources Allocated to
Cover Actually Provided Healthcare
Services in 2016-2018
10
0
100
200
300
400
500
600
700
800
900
2016 2017 2018
22.9 24.9 28.8
475,4
505,1
571,7
CHIFresources,millionEUR
Inpatient services
Other services (specialised outpatient consultations, day care, day surgery, outpatient surgery,
CHIF resources allocated
to cover outpatient and
inpatient healthcare
services in 2018 are
155.7 million. EUR (22.1%)
higher than in 2016
+6,2% +13,2 %
+8,6% +16 %
704,3
753,7
860,0

11. Additionally (Exceeding Contractual Volumes)
Paid Healthcare Services in 2018
(thousand, EUR)
11
Inpatient healthcare services provided to children (under 3 years), or as involuntary
treatment, or by hospitals acting in the catchment area of other Territorial Health
Insurance Fund
5 091,4
4 696,8
4 579,2
2 933,8
2 922,7
2 382,3
1 874,5
1 229,5
701,1
383,7
355,9
325,9
0,0 1 000,0 2 000,0 3 000,0 4 000,0 5 000,0 6 000,0
Day care services
Long term care
Day surgery services
Active treatment and long-term treatment services*
Consultations with diagnostic and treatment
manipulations
Emergency services provided in the Admission
department
Cluster active treatment services
Observation services
Delivery services
Outpatient expensive examinations and procedures
Outpatient surgery services
Consultations of the specialists

12. Distribution of the Contractual Amount by the Types
of Services in 2018 and 2019 (thousand, EUR)
12
580 307
294 387
264 307
73 732
62 293
57 481
522 595
257 246
200 956
61 930
54 748
51 034
0 100 000 200 000 300 000 400 000 500 000 600 000 700 000
Inpatient services
Outpatient services
Primary healthcare services
Nursing and long term
treatment services
Expensive examinations and
procedures
Ambulance services
2019 2018
+31,5%
+12,6%
+19,1%
+14,4%
+11,0%
+13,8%
Consultations of the specialists, day care, day surgery, observation, outpatient surgery services
and emergency services provided in Admission department

13. Strengthen the primary healthcare (20 % of CHIF resources
allocated for the reimbursement of healthcare services )
To reduce the rate of hospitalization
Expand the volume of day care services
Improve the payment of nursing and palliative care services to meet
the needs of an aging society
Future Plans and Developments in the Field
of Healthcare Coverage
13

14. 14
Dynamics of CHIF Budget Expenditure and OOP
for Reimbursed Medicines and Medical Devices
(million EUR)

15. Dynamics of Average CHIF Budget Expenditure
per Prescription and Average Co-payment per
Prescription (EUR), 2004-2015
0.0
5.0
10.0
15.0
20.0
25.0
30.0
2009 m. 2010 m. 2011 m. 2012 m. 2013 m. 2014 m. 2015 m. 2016 m. 2017 m. 2018 m.
17.7
16.2 15.4 16.0 16.8 17.2
18.6
20.1 21.1
24.0
5.4
4.1
3.8
3.9
3.8
4.4
4.7
5.1
5.0
3.9
Average of CHIF expenditures for prescription, EUR Average of co-payment for prescription, EUR

16. Changes of Average Co-payment per
Prescription (EUR)
0.00
1.00
2.00
3.00
4.00
5.00
6.00 5.70
4.70 4.60 4.50 4.60 4.60 4.50 4.60
4.40 4.30
4.60 4.70 4.80
4.00
3.10 3.10 2.99 2.86 2.89
2.31 2.30

17. Patient Co-payment for
Reimbursement of Medical Products
AVERAGE OF PATIENT CO-PAYMENTper PRESCRIPTION:
June 2017– 5,7 EUR
February 2019 – 2,3 EUR
- 60 %
Patient co-payment (million EUR):
2017 – 55
2018 – 40
PATIENT SAVINGS: 15 MILLION EUR

18.  165 thousand low-income people in Lithuania;
 Amendments to the Law on Health Insurance concerning
the exemption of low incomes population from paying co-
payments for subsidised medicines and medical aids is
presented to the Lithuanian Parliament;
 4,1 million EUR – for the implementation of the project
Reduction of OOP on Medicines for the Low-
income Population
18

19. Thank you for your attention!
19