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17 July 2025 | Country Update
Revised indicators for evaluating healthcare facilities -
26 October 2020 | Policy Analysis
Slow progress on the achievement of health policy goals reduced the ability to of health sector to respond to the pandemic -
20 November 2019 | Policy Analysis
Improved Lithuanian health strategy -
23 September 2015 | Policy Analysis
Health system priorities: reducing inequalities and healthy ageing
7.1. Stated objectives of the health system
Political and legal documents describing the objectives of Lithuania’s health system mostly focus on improvement of population health outcomes. According to the Health System Development Dimensions 2011–2020 (Parliament of the Republic of Lithuania, 2011a), the mission of the health system is to motivate people to lead a healthy life, to create incentives for disease prevention and to provide quality care through efficient usage of resources. The Lithuanian Health Programme 2020, which is under preparation at the time of writing, adds health equity to the aims of longer life expectancy, lower mortality and better quality of life. The Law on the Health System states the aims for the entire health sector. These mostly focus on population health: prevention of death, disease and disability; longer healthy life expectancy; improvement of quality of life; and increase in economic and social productivity. It also sets a goal of reduction of inequalities in health between social and professional groups.
Existing health strategies do not have an intersectoral approach, with the exception of a few policies for alcohol and drug control, addiction prevention and road traffic safety. For the period 2008–2012, the government underlined two priorities for intersectoral cooperation: an integrated approach between the health and social sectors in nursing and long-term care and a coordinated effort between the education and health sectors in medical professional training and employment.
The political environment plays a strong role in health sector development. The 15th Lithuanian Government Programme (2008–2012) stated that health reforms are aimed at implementation of modern public health and patient-oriented approaches, rational administration and financing for better accessibility and quality of the services, and elimination of corruption and bureaucracy. The main attention was paid to financing aspects of solidarity (e.g. increasing the state contribution for people insured by the state and stricter eligibility criteria for health insurance coverage), transparency (introduction of co-payments for health services, establishing an information system on contributions and expenditure on individual level), efficiency (allocations of funds for priority areas) and mobilization of resources (creating conditions for supplementary VHI and private capital participation). Reports on actual implementation of reforms mostly reflect progress in restructuring services and the provider network, as well as in pharmaceutical policy (Ministry of Health, 2013). A VHI scheme and regulation for co-payments have not been introduced at the time of writing, which is largely a consequence of negative attitudes among the population (Buivydas et al., 2010).
The Strategy on Implementation of Healthcare Reform Goals and Objectives (2004) and the Implementation Plan (2005–2011) specify the following objectives:
- improving access to and quality of health-care services;
- shifting the focus of public and medical professionals from diagnostics and treatment towards health prevention and healthy lifestyles;
- substituting inpatient care with outpatient services;
- treating at least 75–80% of health problems in primary care;
- optimizing and rationalizing resource allocation through restructuring provider networks and services; and
- increasing funding for equipment upgrading and medical professional wages in line with economic progress and EU integration.
No comprehensive assessments of reforms and health system performance have been conducted. Yet some evidence can be found in the following sources:
- annual reports of major public authorities (e.g. Ministry of Health, NHIF);
- reports of the National Audit Office of Lithuania Inspectorate, which typically prioritizes selected issues;
- evaluations related to investments from the EU structural funds, including a recent series of studies undertaken to improve public awareness and dissemination;
- some research initiatives, mostly under international projects, as well as surveys commissioned by authorities;
- annual reports of the National Health Board, which contain collections of publications devoted to important public health topics; and
- situation analyses as introductory parts of policy documents.
From 2025, the Ministry of Health introduced revised criteria for evaluating the performance of healthcare facilities. In addition to operational efficiency and financial performance, indicators related to patient satisfaction, personnel turnover and avoidable hospitalizations will now be assessed.
The evaluation objectives vary according to the type of facility (for example, primary care centres, rehabilitation and nursing facilities, blood banks and ambulance services). The aim is to encourage facilities to use financial resources more responsibly, to improve coordination of services, and to provide better quality, patient-centred care.
Performance is measured and aggregated across indicators, affecting a pay-for-performance share of healthcare facilities managers’ salary. Institutions with poor year-end financial performance receive lower scores, thus impacting the salaries of the heads of public healthcare facilities.
Authors
On September 2nd 2020, the State Control office released a routine report on the progress of implementation of the earlier State Audit recommendations in reforming various public sector areas, including health care, over the past three years. The report evaluated the state of progress in the first half of 2020, however it noted that much of this period coincided with unprecedented emergency response to the COVID-19 pandemic. Therefore the report evaluated the progress from three angles: i) whether implementation of recommendations is conductive to COVID-19 emergency response; ii) progress in areas which are crucial to state functioning; iii) adoption of legislation relevant to recommendations.
For health care, it was noted that the MOH has made progress towards improving quality, access and patient-centredness, in line with the existing strategies, yet a number of challenges remain, with actions still needed on:
- Improvement of access to outpatient rehabilitation services for children living in municipalities where these services are not provided;
- Reduction of waiting times through monitoring and analysis of patient flows;
- Creation of effective system for determining and further development of skills and competences for health care specialists;
- Clarifying the scope of the NHIF benefits package and determining the appropriate cost of health care services;
- Increasing administrative efficiency through simplification in NHIF governance structures. In this respect, the State Audit report noted that the change to the Health Insurance Law is underway to simplify the structure of the NHIF and reduce fragmentation by merging existing five regional branches into a single legal entity.
The State Audit noted that the health sector would be in a stronger position to respond to the COVID-19 pandemic if the recommendation to have a well-functioning information system infrastructure and processes (including monitoring patient access to services, reporting adverse events, etc), as well as the development of health care specialists’ competences assessment model had been implemented in time (in the course of 2020).
Authors
In October 2019 the Parliament approved the updates to the Lithuanian Health Strategy for 2014-2025. According to the Ministry, the strategy has been adjusted to reflect current situation and the provisions of international strategic documents. The strategy’s key indicator is to achieve life expectancy of 77.5 years by 2025. Four main objectives are: 1) to create a safer social environment, reduce health inequalities and social exclusion, 2) to create a healthier work and living environment, 3) to form healthy lifestyles and culture, 4) to ensure efficient high-quality people-centred health care.
The updated strategy has substantial adjustments to three of those objectives. The objective of creating a healthier working and living environment has been complemented with the provision to ensure sustainability; municipalities have been empowered to play a greater role in building a healthier communities by supporting local initiatives aiming to tackle determinants of health and promote health literacy.
The objective to form healthy lifestyles and culture has been complemented by three tasks, with a particular focus on promotion of mental health and prevention of suicide through improvement of access to mental health care services, and strengthening of prevention measures for people at high risk of suicide.
The objective of ensuring efficient and high-quality people-centred care now includes requirement to plan training of health professionals according to population needs. Other changes include stipulated need for effective emergency care services, as well as upgrade for urgent care and diagnostics infrastructure.
References
Parliament of the Republic of Lithuania (2019) https://www.e-tar.lt/portal/lt/legalAct/85dc93d000df11e4bfca9cc6968de163/asr
One of the main priorities in Lithuania’s health system in 2014-2023 are reduction of health inequalities and enabling healthy ageing. Both priorities were reflected in adopting the corresponding Action Plans (on Reduction of Health Inequalities and on Healthy Ageing respectively), in July 2014. The funding is envisaged to come mainly from the EU Structural and Investment Funds (210 mln EUR for reducing inequalities and further 40 mln EUR for enabling healthy ageing). The funding is envisaged to be distributed on a competitive basis among service providers, the Ministry of Health, universities municipalities, NGOs and other organisations.
This Action Plan on Reduction in Health Inequalities focusses on a number of health areas: cardio-vascular diseases, child health, cancer, TB, traumas and external causes of ill-health, health care for persons with disabilities, as well as addiction disorders. It mainly covers improvements in infrastructure for provision of services (prevention, diagnostics and treatment), quality of service provision as well expansion of access to care.
The Healthy Ageing Action Plan highlights the importance of healthy lifestyle and preventive interventions (including increase in physical activity, expanding flu vaccination coverage, prevention of falls, improvements in infrastructure, access to and quality of geriatric and nursing services).
Authors
References
MOH (2014) 2014–2020 Financial cycle: national planning and competitive allocation of funds envisaged to reduce health inequalities
MOH (2014) Discussion on implementation of projects in health using 2014-2020 EU Structural and Investment Funds