OREANDA-NEWS. March 14, 2011. According to the latest "DnB NORD Latvian barometer", the country's population is dissatisfied with the quality of the existing healthcare system, pointing out to its incompliance with the actual needs and costliness of its services. Moreover, in opinion of respondents, improvements can be brought not only by additional funding, but rather by serious changes in the system itself, reported the press-centre of DnB NORD.

More than 80% of respondents believe that the healthcare system in Latvia does not satisfy the needs of general public, among main reasons behind its inefficiency mentioning costly medicine (72%) and medical services (67%), as well as lacking funding (64%). Part of respondents reckons as principal problem never-ending changes within the system and inconsistency in decisions (41%), as well as inadequate attitude towards patients by medical staff (38%).

When asked about comments on costliness of services and the medicine in particular the Director of "Gimenes aptiekas" pharmacy chain Ilgvars Kipens explains the public opinion by comparing the accessible data on medication prices and wages in Latvia and other European countries: "Several studies independently conducted by state authorities and private enterprises reveal that medication in Latvia on average is cheaper than in other countries of the European Union, whereas people are convinced about the opposite - 72% of respondents believe that we are the ones paying more on medicine.

I think that underlying such assumption is the fact that locally the amount earmarked for medicine from the family's budget pro rata is higher, as our wages are considerably lower as compared to mean European salaries. Average wages in Latvia according to the Central Bureau of Statistics amounts to approx. LVL 431 before taxes, meaning that the person is paid some 300 lats "in red", whereas, for instance, in United Kingdom an employed person takes home 1,500 lats on average. Assuming that a remedy costs five lats and the price is equal both in here and in UK, the calculation reveals that Latvian pays for it 1.6% of the salary, whereas Englishman - mere 0.3%. The difference is enormous, and is causing the feeling that we pay more for medicine and other goods, even though the amounts are similar in terms of pricing."

When asked to assess the quality of the existing healthcare system and to think about possible improvements, more than one half or 58% respondents are convinced that the system must be subjected to radical changes, whereas 33% point out to the need to obtain higher financial assignments. Yet, regardless of the wish to experience reforms within the healthcare system, more than one half of respondents are not supportive to the currently launched reform of hospitals, believing that its goals do not correspond with the best interests of the population, and other 43% reckon that its implementation is inefficient.

Chairman of the Board of "ARS" Medical Service Company Maris Andersons, commenting on the people's criticism concerning the healthcare system complete with reforms launched by now, emphasises: "Already now Latvia falls short of the criteria drawn by the European Union stipulating that emergency services should be accessible within the distance of 70 kilometres or paramedics should arrive within an hour after the call. If accessibility of medical assistance will deteriorate further, prevalence of neglected illnesses and the number of people in need of time-consuming therapy will grow (and treatment of neglected maladies is more costly from governmental point of view). Unfortunately, even actual trends are rather discouraging, as hospitals report that over the last year has drastically augmented the number of pathologies, whereas the number of Group I disabled persons has grown by 50%. Mind you that these people stand no chance in returning to the labour market."

"DnB NORD Latvian barometer" has also discovered that some part of population would gladly assume the responsibility for healthcare contributions, thus reducing payable taxes (43%), rather than pay higher tax to enable the government to provide wider range of state-paid services.

"Since people in Latvia mostly mistrust the taxation system as such (which was revealed by the precedent "DnB NORD Latvian barometer" survey), it is quite logical that the population would rather opt for greater self-responsibility for insurance and healthcare contributions. However, this assessment is not quite unbiased, as Latvians unfortunately are not accustomed to taking care of their own health or assume full responsibility for it.  Besides, to afford health insurance one needs rather high income the majority of population is unfortunately deprived of," reasons the Chairperson of the Patients' Ombud Office Liene Sulce.

The survey further detected that the majority of respondents tend to visit their family doctor only in case of serious illness or if self-treatment has failed (44%), as well as in emergency cases or to obtain the prescription for vital medication (40%). Mere 14% of respondents visit the doctor as soon as there appears the slightest concern about their health or that of their family members. As one of principal obstacles that preclude from visiting the family doctor the population mention costliness of medical services (50%).

In turn, when assessing their relations with family doctor close to one half of respondents admit that they trust their physician (47%); 41% of respondents in case of health problems turn to their doctor in the first instance, whereas equal proportion of respondents mostly visit their family doctor to obtain assignments to specialists. 

When asked about the doctors' remuneration, this being the question that has stirred occasional public discussions at least over the last ten years, 31% respondents have specified that they are not actually aware of it, whereas 22% regard it as too low. 40% of the poll participants consider the remuneration of paramedics and medics more or less adequate to the current situation in Latvia (24%) or even higher than the average income of other specialists (16%).

"Due to unknown reasons there still persists the notion that doctors' earnings are quite adequate, even though it is very well known that taking into account the huge responsibility and knowledge that is tough to master physicians for a workload gain less than the average salary within the economy. Therefore, unanswered remains the question whether the people are aware of the fact that doctors mostly earn their wages being occupied in at least two workplaces and taking several workloads?" asks the President of Latvian Medical Association Peteris Apinis.

In the newest issue of "DnB NORD Latvian barometer" people also were asked to describe their position towards the questionable issue of gifts and unofficial payments to medical staff. The results imply that 51% of respondents consider any further material gratitude in addition to the officially stipulated price for the service inappropriate, whereas 42% of respondents are supportive to at least small gift or presentation of cash. 

Chairperson of the Patients' Ombud Office Liene Sulce points out: "As to the question of unofficial contributions, one must admit that the system and its quality will not improve as long as the people are ignorant of or refuse to accept the fact that such unofficial payments are absolutely inacceptable. It lies also within the responsibility of patients themselves - to abstain from illicit payments and report any requests of such, as well as to be aware that the provided services are covered from the state budget or one's own pocket. This is the question of values; and let us hope that the situation will gradually change, as this soviet legacy seems embarrassing to many specialists from European countries. It should be advisable to explain to the population that there are also legitimate and positive ways of showing one's gratitude. If the patient is well-off enough to afford monetary gratification to the medical institution it can be executed as official donation for its development, new equipment or staff bonuses."

Last, but not least the respondents have expressed their opinion on launching of electronic database providing for placement of medical records in Internet. The majority or 58% of participants would object to inclusion of their information in databases due to disinclination to let anybody to read through their medical records. Supportive to e-healthcare project are 27% of respondents, believing that it would contribute to improvement of treatment quality.

The President of Latvian Association of Countryside Family Doctors Liga Kozlovska points out that medical records in Internet entails both ethical and patient's rights issues, as any medical consultation to the patient actually is very intimate and privileged: "Confidentiality is one of those factors that secure the patient's confidence in the doctor, and no treatment can be efficient enough without confidence. Such database might be of assistance in some particularly complicated cases, and therefore all doctors should not gain access to the totality of medical records of every patient." 

Chairman of the Board of Medical Service Company "Mediconsult MS" Maris Mezeckis, on the contrary, considers peoples' concerns about placement of their information within unified database unfounded. "Appropriately executed digital patient's card (or medical record) will be accessible to the doctor in charge only and just in case it is required for provision of medical services. State-of-the-art information technologies are advanced enough to secure that to no doctor save those directly involved in the treatment process is granted access to the information to make the system leak-proof and ensuring records on the information review history, so that in case of leakage one could easily track down the responsible persons," explains the expert. 

"DnB NORD Latvian barometer" has become renowned monthly sociologic study in the country and appears on monthly basis. It focuses on the hottest issues of the given period; yet at the same time to the general public every time is addressed the list of regular questions that month by month indicate changes in the public sentiments.March 14, 2011. According to the latest "DnB NORD Latvian barometer", the country's population is dissatisfied with the quality of the existing healthcare system, pointing out to its incompliance with the actual needs and costliness of its services. Moreover, in opinion of respondents, improvements can be brought not only by additional funding, but rather by serious changes in the system itself, reported the press-centre of DnB NORD.

More than 80% of respondents believe that the healthcare system in Latvia does not satisfy the needs of general public, among main reasons behind its inefficiency mentioning costly medicine (72%) and medical services (67%), as well as lacking funding (64%). Part of respondents reckons as principal problem never-ending changes within the system and inconsistency in decisions (41%), as well as inadequate attitude towards patients by medical staff (38%).

When asked about comments on costliness of services and the medicine in particular the Director of "Gimenes aptiekas" pharmacy chain Ilgvars Kipens explains the public opinion by comparing the accessible data on medication prices and wages in Latvia and other European countries: "Several studies independently conducted by state authorities and private enterprises reveal that medication in Latvia on average is cheaper than in other countries of the European Union, whereas people are convinced about the opposite - 72% of respondents believe that we are the ones paying more on medicine.

I think that underlying such assumption is the fact that locally the amount earmarked for medicine from the family's budget pro rata is higher, as our wages are considerably lower as compared to mean European salaries. Average wages in Latvia according to the Central Bureau of Statistics amounts to approx. LVL 431 before taxes, meaning that the person is paid some 300 lats "in red", whereas, for instance, in United Kingdom an employed person takes home 1,500 lats on average. Assuming that a remedy costs five lats and the price is equal both in here and in UK, the calculation reveals that Latvian pays for it 1.6% of the salary, whereas Englishman - mere 0.3%. The difference is enormous, and is causing the feeling that we pay more for medicine and other goods, even though the amounts are similar in terms of pricing."

When asked to assess the quality of the existing healthcare system and to think about possible improvements, more than one half or 58% respondents are convinced that the system must be subjected to radical changes, whereas 33% point out to the need to obtain higher financial assignments. Yet, regardless of the wish to experience reforms within the healthcare system, more than one half of respondents are not supportive to the currently launched reform of hospitals, believing that its goals do not correspond with the best interests of the population, and other 43% reckon that its implementation is inefficient.

Chairman of the Board of "ARS" Medical Service Company Maris Andersons, commenting on the people's criticism concerning the healthcare system complete with reforms launched by now, emphasises: "Already now Latvia falls short of the criteria drawn by the European Union stipulating that emergency services should be accessible within the distance of 70 kilometres or paramedics should arrive within an hour after the call. If accessibility of medical assistance will deteriorate further, prevalence of neglected illnesses and the number of people in need of time-consuming therapy will grow (and treatment of neglected maladies is more costly from governmental point of view). Unfortunately, even actual trends are rather discouraging, as hospitals report that over the last year has drastically augmented the number of pathologies, whereas the number of Group I disabled persons has grown by 50%. Mind you that these people stand no chance in returning to the labour market."

"DnB NORD Latvian barometer" has also discovered that some part of population would gladly assume the responsibility for healthcare contributions, thus reducing payable taxes (43%), rather than pay higher tax to enable the government to provide wider range of state-paid services.

"Since people in Latvia mostly mistrust the taxation system as such (which was revealed by the precedent "DnB NORD Latvian barometer" survey), it is quite logical that the population would rather opt for greater self-responsibility for insurance and healthcare contributions. However, this assessment is not quite unbiased, as Latvians unfortunately are not accustomed to taking care of their own health or assume full responsibility for it.  Besides, to afford health insurance one needs rather high income the majority of population is unfortunately deprived of," reasons the Chairperson of the Patients' Ombud Office Liene Sulce.

The survey further detected that the majority of respondents tend to visit their family doctor only in case of serious illness or if self-treatment has failed (44%), as well as in emergency cases or to obtain the prescription for vital medication (40%). Mere 14% of respondents visit the doctor as soon as there appears the slightest concern about their health or that of their family members. As one of principal obstacles that preclude from visiting the family doctor the population mention costliness of medical services (50%).

In turn, when assessing their relations with family doctor close to one half of respondents admit that they trust their physician (47%); 41% of respondents in case of health problems turn to their doctor in the first instance, whereas equal proportion of respondents mostly visit their family doctor to obtain assignments to specialists. 

When asked about the doctors' remuneration, this being the question that has stirred occasional public discussions at least over the last ten years, 31% respondents have specified that they are not actually aware of it, whereas 22% regard it as too low. 40% of the poll participants consider the remuneration of paramedics and medics more or less adequate to the current situation in Latvia (24%) or even higher than the average income of other specialists (16%).

"Due to unknown reasons there still persists the notion that doctors' earnings are quite adequate, even though it is very well known that taking into account the huge responsibility and knowledge that is tough to master physicians for a workload gain less than the average salary within the economy. Therefore, unanswered remains the question whether the people are aware of the fact that doctors mostly earn their wages being occupied in at least two workplaces and taking several workloads?" asks the President of Latvian Medical Association Peteris Apinis.

In the newest issue of "DnB NORD Latvian barometer" people also were asked to describe their position towards the questionable issue of gifts and unofficial payments to medical staff. The results imply that 51% of respondents consider any further material gratitude in addition to the officially stipulated price for the service inappropriate, whereas 42% of respondents are supportive to at least small gift or presentation of cash. 

Chairperson of the Patients' Ombud Office Liene Sulce points out: "As to the question of unofficial contributions, one must admit that the system and its quality will not improve as long as the people are ignorant of or refuse to accept the fact that such unofficial payments are absolutely inacceptable. It lies also within the responsibility of patients themselves - to abstain from illicit payments and report any requests of such, as well as to be aware that the provided services are covered from the state budget or one's own pocket. This is the question of values; and let us hope that the situation will gradually change, as this soviet legacy seems embarrassing to many specialists from European countries. It should be advisable to explain to the population that there are also legitimate and positive ways of showing one's gratitude. If the patient is well-off enough to afford monetary gratification to the medical institution it can be executed as official donation for its development, new equipment or staff bonuses."

Last, but not least the respondents have expressed their opinion on launching of electronic database providing for placement of medical records in Internet. The majority or 58% of participants would object to inclusion of their information in databases due to disinclination to let anybody to read through their medical records. Supportive to e-healthcare project are 27% of respondents, believing that it would contribute to improvement of treatment quality.

The President of Latvian Association of Countryside Family Doctors Liga Kozlovska points out that medical records in Internet entails both ethical and patient's rights issues, as any medical consultation to the patient actually is very intimate and privileged: "Confidentiality is one of those factors that secure the patient's confidence in the doctor, and no treatment can be efficient enough without confidence. Such database might be of assistance in some particularly complicated cases, and therefore all doctors should not gain access to the totality of medical records of every patient." 

Chairman of the Board of Medical Service Company "Mediconsult MS" Maris Mezeckis, on the contrary, considers peoples' concerns about placement of their information within unified database unfounded. "Appropriately executed digital patient's card (or medical record) will be accessible to the doctor in charge only and just in case it is required for provision of medical services. State-of-the-art information technologies are advanced enough to secure that to no doctor save those directly involved in the treatment process is granted access to the information to make the system leak-proof and ensuring records on the information review history, so that in case of leakage one could easily track down the responsible persons," explains the expert. 

"DnB NORD Latvian barometer" has become renowned monthly sociologic study in the country and appears on monthly basis. It focuses on the hottest issues of the given period; yet at the same time to the general public every time is addressed the list of regular questions that month by month indicate changes in the public sentiments.