April 2007
By Ilze Barone, MD, EQuiP member
Recent developments in Latvia
The present health care policy has declared orientation towards promoting primary and preventive health care. The aim is set, that the individual family physician practices should become the basic units of health care instead of policlinics, and GPs should work as independent practitioners under contracts with Health Compulsary Insurance State Agency – an institution that manages state resources for health care provision.
Currently 1500 general practitioners are working independently as privat providers in primary care, having contract. Some GPs work as employers in outpatientclinics, small part of GPs work completely privately without the contract. The average number of patients registered with one GP is about 1700.
The financial model is the mixed capitation and fee for service payment.
There are some quality criteria included in the financial model: the number of preventive checkups , number of vaccinations done according to the national immunization programm and the number of particular cancer screening investigations.
Latvian primary care system suffers from insufficient funding , therefore in 2007 only 14 % of financing for health care services are for the primary health care. The permanent changes of PHC policy causes uncertainty of family doctors. There are lack of general practitioners in rural areas. The waiting time for patients with chronic conditions is one to five days. Patients with acute problems see family doctor in the same day.
In 2003 Latvian Family Physicians Association started discussions with Ministry of Health concerning the planned changes in the model of primary health care. The discussion grew till the scope of public discussion on remuneration of the GPs work, quality of GPs work, attitude of GPs to the patients, and, finally about the health care policy and health care system in Latvia and its bottlenecs in general. As a result in
2004 the new Regulations of Cabinet of Ministers were accepted regulating the organization and financing of the health care system. Unfortunately, the primary health care policy changed again, by new regulations of Cabinet of Ministers, issued in December 2006. The new policy stressed on preventive care, financially motivating GPs perform profilactic checkups in all group of patients.
The Latvian Family Physicians’Association - the Professional organization for family physicians consisting of 1400 members and it is about 95% of those working in the primary care. Another Professional organization exists: Latvian Rural Family Physicians’ Association, founded in 1999 and having about 400 members, mostly rural family doctors.
Education
The academic education for family doctors at both Universities in Latvia include 6 years undergraduate and 3 years of residency studies, 2 of them are spent in a clinic with periodical stay in GP practice, and 1 year is spent in GP practice. The undergraduate students get the new challenge, started in 2006 – two weeks training in family doctors’ practices during 6th year of studies. The new problem emerge with this – how to motivate the teaching family doctors beeing tutors. After the studies and certification exam the family doctor can start an independent practice. The new Ministry of Health proposal announced in 2007 is to shorten residency studies in family medicine to two years, motivating it by necessity to hasten process of education , because there is a lack of family doctors in Latvia. The Family Physicians Association holds the positions to keep the previous lengt of residency studies , that is, 3 years in order to ensure the quality of competence of new family doctors.
CME and quality measures, accreditation
The certification and mandatory recertification of family doctors are set in the area of
responsibility of Latvian Family Physicians Association. The new rules for
certification and recertification are developed by Association during the last two years, and are based on points from activities such as conventional postgraduate training, conferences, courses, scientific publications, small group work, academic work, other educational and Professional development. In Continuous Medical Education, that is used as a major tool for ensuring quality of practice, each 5 years 250 credit points should be gained.
The professionaly developed certification exam is the future challenge.
An evaluation of GP practices conformity, as the requirement of the Cabinet of
Ministers, is in force since 2000. An independent governmental institution - Health
Statistics and Medical Technologies Agency carries out evaluation of practices.
Technological and material equipment of a practice, documentation and information
for patients are evaluated. Almost all GPs practices are evaluated as conformable. Only in case of conformity of the individual GP practice the doctor can sign the contract with governmental agency for to receive state financing for primary care.
The future task is to find motivation for GPs to perform the quality measurements in
their practices.
Other projects
Initiatives of Latvian Family Physicians Association
