study financing of health care system of lithuania and accessibility of health care services to...

Study Financing of Health Care System of

Lithuania and Accessibility of Health Care Services to Population

The Study has been prepared by the Centre of Health Economy UAB in cooperation with the

Association of Representative Offices of Ethical Pharmaceutical Manufacturers

August 2006

CONTENTS

THE OBJECTIVE OF THE STUDY REFERENCES WORK METHODOLOGY

DEMOGRAPHICAL AND HEALTH INDICATORS IN LITHUANIA AND IN THE EU COUNTRIES BASIC ECONOMICAL AND SOCIAL INDICATORS IN LITHUANIA AND IN THE EU COUNTRIES RESOURCES AND FUNCTIONING OF HEALTH CARE SYSTEM OF LITHUANIA FINANCING OF HEALTH CARE SERVICES IN LITHUANIA

Public financing of health system of Lithuania

Financing of health system of Lithuania from private funds

Medicament usage by population of Lithuania and its financing

ANALYSIS AND PROPOSALS ON THE TRENDS OF HEALTH CARE SERVICES IN LITHUANIA

THE OBJECTIVE OF THE STUDY

The main objective of this study is to analyse possibilities to secure

sustained and stable development of health care services in Lithuania

REFERENCES EUROSTAT NEWS RELEASE, 48/2005 - 8 April 2005. Population projections 2004-2050 Eurostat, 2006; Eurostat/U.S. Bureau of the Census IMS Health Map of Corruption in Lithuania, 2004; 2005. Annual reports on the implementation of the budget of the Republic of Lithuania, 2003-2005. Lithuanian Health Information Centre. Ministry of Finance of the Republic of Lithuania. The projections of economic indicators in Lithuania

for the years 2006–2009. The Projections were published on 28.04.2006. OECD 2000. Methodology on Health Accounting. OECD Health Data, 2005 Research on Officially Unaccounted Economy in Lithuania, Vilnius 2004. Department of Statistics

under the Government of the Republic of Lithuania. SEB Vilniaus Bankas. Department of Statistics under the Government of the Republic of Lithuania. Department of Statistics under the Government of the Republic of Lithuania. Results of the research

of household budgets in 1996 – 2005. The impact of ageing on public expenditure: projections for the EU25 Member States on pensions,

health care, long-term care, education and unemployment transfers (2004-2050). Report prepared by the Economic Policy Committee and the European Commission (DG ECFIN) Brussels, 6 February 2006, ECFIN/EPC(2006)REP/238

Insurance Supervisory Commission under the Ministry of Finance; Insurance in Lithuania, reviews of the years 2002-2004.

State Patient Fund. WHO, European health for all database, 2006.

WORK METHODOLOGY

During the course of the study :The analysis of health, economic and social indicators of the population of Lithuania

has been performed comparing them with other EU countries.

The situation of the health care system of Lithuania in the context of the European Union has been analysed: the resources of the health system of Lithuania, the financial resources, the trends of their changes and factors influencing these trends as well as the legal provisions regulating the health system of Lithuania have been analysed. The information has been collected in cooperation with the responsible officers and specialists of the public authorities of Lithuania. Official Lithuanian and EU databases as well as other information resources have been used.

Conclusions and recommendations have been prepared in order to secure permanent and stable development of the health care system of Lithuania towards the EU standards.

DEMOGRAPHICAL AND HEALTH INDICATORS IN LITHUANIA AND IN

OTHER EU COUNTRIES

The EU population (% of the total number of EU population), 2005

Eurostat/U.S. Bureau of the Census

18,0%

13,2% 13,1% 12,7%

9,4%

8,3%

3,5%

2,4% 2,3% 2,3% 2,2% 2,2% 2,0% 1,8%1,2% 1,2% 1,1% 0,9% 0,7% 0,5% 0,4% 0,3% 0,2% 0,1% 0,1%

0%

4%

8%

12%

16%

20%G

erm

any

Fran

ce

Uni

ted

Kin

gdom

Italy

Spai

n

Pola

nd

Net

herla

nds

Gre

ece

Port

ugal

Bel

gium

Cze

ch R

epub

lic

Hun

gary

Swed

en

Aus

tria

Den

mar

k

Slov

akia

Finl

and

Irela

nd

Lith

uani

a

Latv

ia

Slov

enia

Esto

nia

Cyp

rus

Luxe

mbo

urg

Mal

ta

ES (25 šalys) gyventojų skaičius 2005 m. - 459488,418,0%

13,2% 13,1% 12,7%

9,4%

8,3%

3,5%

2,4% 2,3% 2,3% 2,2% 2,2% 2,0% 1,8%1,2% 1,2% 1,1% 0,9% 0,7% 0,5% 0,4% 0,3% 0,2% 0,1% 0,1%

0%

4%

8%

12%

16%

20%G

erm

any

Fran

ce

Uni

ted

Kin

gdom

Italy

Spai

n

Pola

nd

Net

herla

nds

Gre

ece

Port

ugal

Bel

gium

Cze

ch R

epub

lic

Hun

gary

Swed

en

Aus

tria

Den

mar

k

Slov

akia

Finl

and

Irela

nd

Lith

uani

a

Latv

ia

Slov

enia

Esto

nia

Cyp

rus

Luxe

mbo

urg

Mal

ta

EU (25 countries) number of population in 2005 - 459488.4

Eurostat, 2006

Trends of the EU population number changes (in millions), 2005-2050

*- Estimates are made using the latest available figures for the population on 1 January. In general, key assumptions are made with respect to mortality, fertility and migration by sex and by age, and ageing techniques are applied to the population pyramid from year to year.

350

370

390

410

430

450

470

490

2005 2010 2015 2020 2025 2030 2035 2040 2045 2050

EU (25 countries) EU (15 countries)

Trends of the Baltic States population number changes, (in millions),

2005-2050

Eurostat, 2006

0,0

1,0

2,0

3,0

4,0

2005 2010 2015 2020 2025 2030 2035 2040 2045 2050

Estonia Latvia Lithuania

The EU population: number of newborns per 1000 citizens, 2004

12,0 12,0 11,9 11,911,3 11,1

10,7 10,6 10,4 10,4 10,49,7 9,7 9,6 9,6 9,4 9,3

8,9 8,9 8,8 8,6

4

56

7

89

10

1112

13Lu

xem

bour

g

Uni

ted

Kin

gdom

Den

mar

k

Net

herla

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Cyp

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Finl

and

Spai

n

EU m

embe

rs b

efor

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ay 2

004 EU

Port

ugal

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nia

Mal

ta

Aus

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ch R

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EU m

embe

rs s

ince

May

200

4

Pola

nd

Slov

enia

Lith

uani

a

Latv

ia

Ger

man

y

Per 1

000

popu

latio

n

WHO, European health for all database, 2006

The new EU countries population: the changes of newborn number per 1000 citizens, 1990-2004

7,0

8,0

9,0

10,0

11,0

12,0

13,0

14,0

15,0

16,019

90

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

Per 1

000

popu

latio

n

LithuaniaCzech RepublicEstoniaHungaryLatviaSloveniaEU


The EU population: infant mortality rate (per 1000 live births), 2004


9,4

7,9

6,8 6,5 6,45,9

5,1 4,7 4,5 4,4 4,4 4,1 4,1 4,0 3,8 3,7 3,5 3,3 3,0

0,01,02,03,04,05,06,07,08,09,0

10,0La

tvia

Lith

uani

a

Pola

nd

EU m

embe

rs s

ince

May

200

4

Esto

nia

Mal

ta

Uni

ted

Kin

gdom EU

Aus

tria

EU m

embe

rs b

efor

e M

ay 2

004

Net

herla

nds

Ger

man

y

Gre

ece

Spai

n

Cze

ch R

epub

lic

Slov

enia

Luxe

mbo

urg

Finl

and

Cyp

rus

Infa

nt m

orta

lity

per 1

000

live

birt

hs

The new EU countries population: the changes of infant mortality rate (per 1000 live births), 1990-2004


0

2

4

6

8

10

12

14

16

18

2019

90

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

Infa

nt m

orta

lity

per 1

000

live

birt

hs


The EU population: average life expectancy at birth, 2004


80,579,6 79,5 79,5 79,4 79,4 79,4 79,4 79,1 79,0 79,0 78,6

77,376,0

75,0 74,6

72,3 72,171,3

66

68

70

72

74

76

78

80

82Sp

ain

Luxe

mbo

urg

Cyp

rus

Aus

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ta

EU m

embe

rs b

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ay 2

004

Net

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Ger

man

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Gre

ece

Uni

ted

Kin

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Finl

and EU

Slov

enia

Cze

ch R

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lic

Pola

nd

EU m

embe

rs s

ince

May

200

4

Esto

nia

Lith

uani

a

Latv

ia

Age

The new EU countries population: changes of life expectancy at birth, 1990-2004


64

66

68

70

72

74

76

78

8019

90

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

Age


The EU population: average healthy life expectancy (HALE) in years, 2002

In 2000 in Lithuania – 60.8, EU average – 69.19, in 2001 in Lithuania– 61.1, EU average – 69.36.WHO, European health for all database, 2006 (World Health Report 2004)

73,3 72,7 72,6 72,0 71,8 71,7 71,5 71,4 71,2 71,1 71,1 71,0 71,0 70,8 70,669,8 69,8 69,5 69,2

68,467,6

66,2 66,0 65,864,9

64,163,3 62,8

56,058,060,062,064,066,068,070,072,074,076,0

Swed

en

Italy

Spai

n

Fran

ce

Ger

man

y

EU m

embe

rs b

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ay 2

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Luxe

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urg

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Net

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Finl

and

Bel

gium

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Mal

ta EU

Uni

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Kin

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Den

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Port

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Cze

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EU m

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May

200

4

Pola

nd

Hun

gary

Esto

nia

Lith

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Latv

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Age

The EU population: mortality (per 1000 population), 2003

13,9513,41 13,41

11,8710,91 10,56 10,42 10,35 10,26 9,89 9,76 9,74 9,57 9,56 9,51 9,41 9,32 9,16 8,92 8,75

0

2

4

6

8

10

12

14

16La

tvia

Esto

nia

Hung

ary

Lith

uani

a

Czec

h Re

publ

ic

EU m

embe

rs s

ince

May

200

4

Portu

gal

Ger

man

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Unite

d Ki

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m EU

EU m

embe

rs b

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ay 2

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Slov

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Gre

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Pola

nd

Aust

ria

Finl

and

Norw

ay

Spai

n

Luxe

mbo

urg

Neth

erla

nds


The new EU countries population: mortality (per 1000 citizens), 1990-2004


8

9

10

11

12

13

14

15

16

1719

90

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

Per 1

000

popu

latio

n

LithuaniaLatviaEstoniaHungaryCzech RepublicEUSlovenia

EU standartized mortality rate per 100,000 population in the EU countries: heart and circulatory system diseases, 2003


206

149135 132

117 117 112 11095

7969 66 65 65 61 57 56 53 52 50

0

50

100

150

200

250

Latv

ia

Esto

nia

Hun

gary

Cze

ch R

epub

lic

Lith

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a

Port

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Gre

ece

EU m

embe

rs s

ince

May

200

4

Pola

nd

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Mal

ta EU

Uni

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n

Net

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Per 1

00,0

00 p

opul

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n

EU standartized mortality rate per 100,000 population in the new EU countries: changes in the mortality from heart and circulatory system

diseases, 1990-2004


40

90

140

190

240

29019

90

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

Per 1

00,0

00 p

opul

atio

n

LithuaniaCzech Republic

EstoniaHungaryLatviaSlovenia

EU

EU standartized mortality rate per 100,000 population in the EU countries: oncology diseases, 2003


264

234221 215

204 194 194 194 191 186 185 178 177 173 173 167 161 161 158146

0

50

100

150

200

250

300

Hun

gary

Cze

ch R

epub

lic

EU m

embe

rs s

ince

May

200

4

Pola

nd

Slov

enia

Esto

nia

Latv

ia

Lith

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Net

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Uni

ted

Kin

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EU

EU m

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ay 2

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Luxe

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urg

Ger

man

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Aus

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Spai

n

Gre

ece

Port

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Mal

ta

Finl

and

Per 1

00,0

00 p

opul

atio

n

EU standartized mortality rate per 100,000 population in the new EU countries: changes in the mortality from oncology diseases,

1990-2004


170

190

210

230

250

270

29019

90

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

Per 1

00,0

00 p

opul

atio

n


EU standartized mortality rate per 100,000 population in the EU countries : mortality from traumas and poisoning, 2003


148136

129

8072 70 68 64 62

5246 45 43

38 34 34 33 32 29 27

0

20

40

60

80

100

120

140

160

Lith

uani

a

Latv

ia

Esto

nia

Hun

gary

EU m

embe

rs s

ince

May

200

4

Slov

enia

Finl

and

Cze

ch R

epub

lic

Pola

nd

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urg

Port

ugal

Aus

tria EU

EU m

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Ger

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n

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Mal

ta

Net

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Uni

ted

Kin

gdom

Per 1

00,0

00 p

opul

atio

n

EU standartized mortality rate per 100,000 population in the new EU countries: changes in mortality from traumas and poisoning, 1990-

2004


20

70

120

170

220

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

Per 1

00,0

00 p

opul

atio

n



EU

EU standartized mortality rate per 100,000 population in the new EU countries: changes in mortality from respiratory system diseases,

2003


86

7265 62 62 62 60

51 5046 46 43 42 42 41 41 40 39 37

29

0

10

20

30

40

50

60

70

80

90

Uni

ted

Kin

gdom

Mal

ta

Luxe

mbo

urg

Net

herl

ands

Slov

enia

Spai

n

Port

ugal

EU m

embe

rsbe

fore

May

200

4 EU

Gre

ece

Finl

and

EU m

embe

rssi

nce

May

200

4

Ger

man

y

Cze

ch R

epub

lic

Pola

nd

Hun

gary

Aus

tria

Lith

uani

a

Esto

nia

Latv

ia

EU standartized mortality rate per 100,000 population in EU countries: mortality from respiratory system diseases, 1990-

2004


20

30

40

50

60

70

8019

90

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

Per 1

00,0

00 p

opul

atio

n



EU

Trends of changes in population according to age groups in Lithuania (%), 2005-2050 (1)

* - The impact of ageing on public expenditure: projections for the EU25 Member States on pensions, health care, long-term care, education and unemployment transfers (2004-2050) Report prepared by the Economic Policy Committee and the European Commission (DG ECFIN) Brussels, 6 February 2006, ECFIN/EPC(2006)REP/238

According to Eurostat data, in 2004 total number of dependants in Lithuania was 48.6 %. Forecasted percentage of dependants in Lithuania:

in 2025– 52.2 %, in 2050 – 67.8 %.(EUROSTAT NEWS RELEASE, 48/2005 - 8 April 2005. Population projections 2004-2050)

Age 2004 2005 2010 2015 2020 2025 2030 2035 2040 2045 2050Number of population according to age groups (percent of total population)

0-14 17.7 17.1 14.9 14.5 15 15.1 14.7 13.9 13.4 13.3 13.7

25-54 41.8 41.9 43.1 43.8 43.2 42 40.4 39.4 37.9 36 34.6

15-64 67.3 67.6 69 68.9 67.5 65.7 63.9 63.1 62.2 61.4 59.6

65+ 15 15.2 16.1 16.7 17.5 19.2 21.4 23 24.4 25.3 26.7

80+ 2.8 3 3.8 4.5 5 5.2 5.5 6.1 7.2 8.6 9.2Number of population, millions

3.4 3.4 3.3 3.3 3.2 3.1 3.1 3 3 2.9 2.9

Trends of changes in population according to age groups in Lithuania (%), 2005-2050 (2)

17,715,0 15,1 14,7 13,9 13,4 13,3 13,7

41,8 41,9 43,1 43,8 43,2 42,040,4 39,4

37,936,0 34,6

67,3 67,6 69,0 68,9 67,565,7

63,9 63,1 62,2 61,459,6

15,016,7 17,5

19,221,4

23,0 24,4 25,3 26,7

2,8 3,0 3,8 4,5 5,0 5,2 5,5 6,1 7,2 8,6 9,2

14,514,9

17,1

15,216,1

0,0

10,0

20,0

30,0

40,0

50,0

60,0

70,0

2004 2005 2010 2015 2020 2025 2030 2035 2040 2045 2050

Perc

ent

0-14 years

25-54 years

15-64 years

65+ years

80+ years

* - The impact of ageing on public expenditure: projections for the EU25 Member States on pensions, health care, long-term care, education and unemployment transfers (2004-2050) Report prepared by the Economic Policy Committee and the European Commission (DG ECFIN) Brussels, 6 February 2006, ECFIN/EPC(2006)REP/238

CONCLUSIONS

* - The impact of ageing on public expenditure: projections for the EU25 Member States on pensions, health care, long-term care, education and unemployment transfers (2004-2050). Report prepared by the Economic Policy Committee and the European Commission (DG ECFIN) Brussels, 6 February 2006, ECFIN/EPC(2006)REP/238

The number of population in Lithuania is decreasing. During the first years after restoration of independence this was caused by the emigration of part of population to Russia and afterwards – to the Western European countries. Beginning with 1993, the number of newborns started to decrease sharply – in 2004 this number was 8.9/1000 population and it was one of the lowest among the EU countries.

Decrease of the number of newborns influences and will influence population ageing. It is forecasted that in 2020 about 17.5 % of population will be older than 65, and in 2050 this number will increase to 26.7 %.

The growth of average life expectancy in Lithuania, population ageing and reduction of the number of able-bodied population will cause the growth of the number of dependants as well as considerable increase of public expenditures for social benefits, pensions and health care. According to the Eurostat forecast*, the number of dependants in Lithuania can reach about 52.2 percent in 2025 and in 2050 – 67.8 percent.

CONCLUSIONS

* - EUROSTAT NEWS RELEASE, 48/2005 - 8 April 2005. Population projections 2004-2050

Mortality indicators in Lithuania reached their peak in 1994, afterwards the situation has stabilised, however this rate is one of the highest in the EU.

Infant mortality reached the peak in Lithuania in 1992, afterwards the situation has improved, however, based on the data collected in 2004, it is one of the highest in the EU.

Standartized mortality rates from the basic causes of death – heart and circulatory system diseases and malignant tumours - was considerably higher than the EU average, and mortality from accidents and traumas in Lithuania in 2003 was the highest in the EU.

Average life expectancy in Lithuania in 2004 was one of the shortest among the EU countries. Average healthy life expectancy (indicator which shows the duration of quality life – without being disabled) in Lithuania, based on the study performed in 2002 by the World Health Organization, was one of the shortest among the EU countries.

In order to improve the demographical situation, cardinal correction of the health policy and investments to the health sector as well as to other fields having significant impact on the health of population are necessary.

BASIC ECONOMIC AND SOCIAL INDICATORS IN LITHUANIA AND IN THE

EU COUNTRIES

EU countries: GDP in PPS (purchasing power standards), millions, 2005

ES (25 šalys) BVP 2005 m. - 10421643,8 milijonais PPS

Eurostat, 2006

2084001

1631848

992818

249946 235457 216702 175746 175206 156248 145878 139332 13416569730 40706 37831 25962 25142 17577 14647 6561

1590618

1417501

443611471884

287728

0

500000

1000000

1500000

2000000

2500000G

erm

any

Unite

d Ki

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m

Fran

ce Italy

Spai

n

Neth

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Pola

nd

Belg

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Swed

en

Aust

ria

Gre

ece

Portu

gal

Czec

h R

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lic

Den

mar

k

Hung

ary

Finl

and

Irela

nd

Slov

akia

Lith

uani

a

Slov

enia

Luxe

mbo

urg

Latv

ia

Esto

nia

Cypr

us

Mal

ta

EU countries: GDP, percentage of total EU GDP, 2005

Eurostat, 2006

19,3%

15,1% 14,7%13,1%

9,2%

4,4% 4,1%2,7% 2,3% 2,2% 2,0% 1,6% 1,6% 1,4% 1,4% 1,3% 1,2%

0,6% 0,4% 0,4% 0,2% 0,2% 0,2% 0,1% 0,1%0,0%

5,0%

10,0%

15,0%

20,0%

25,0%

Ger

man

y

Uni

ted

Kin

gdom

Fran

ce

Italy

Spai

n

Net

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Pola

nd

Belg

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Swed

en

Aust

ria

Gre

ece

Portu

gal

Cze

ch R

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lic

Denm

ark

Hung

ary

Finl

and

Irela

nd

Slov

akia

Lith

uani

a

Slov

enia

Luxe

mbo

urg

Latv

ia

Esto

nia

Cyp

rus

Mal

ta

EU countries: GDP per capita in PPS (purchasing power standards), 2005

Eurostat, 2006

56900

32400

28900 28800 28600 27700 27500 27100 2660025500 25300 25300

24200 23400 23000

19600 19600 1890017100 16600 16200

1450013000 12900 11900 11600 10900

0

10000

20000

30000

40000

50000

60000Lu

xem

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g

Irela

nd

Net

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ands

Den

mar

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Aust

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Sw

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Belg

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Uni

ted

Kin

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Finl

and

Fran

ce

EU

(15

coun

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s)

Ger

man

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Italy

EU

(25

coun

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s)

Spai

n

Gre

ece

Cyp

rus

Slo

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Cze

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Portu

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Slo

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Pol

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Latv

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The growth of GDP per capita in PPS (purchasing power standards) in the EU member countries , 1996-2007

Eurostat, 2006

6000

8000

10000

12000

14000

16000

18000

20000

22000

24000

26000

2800019

96

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

PPS

per c

apita

EU (15 countries)

EU (25 countries)

EU (10 newcountries)

The growth of GDP per capita in PPS (purchasing power standards) in the Baltic States , 1996-2007

Eurostat, 2006

4000

6000

8000

10000

12000

14000

1600019

96

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

PPS

per c

apita

EstoniaLithuaniaLatvia

The comparison of the growth of GDP in PPS (purchasing power standards) in the EU countries and Lithuania

(in percent, 1996 = 100 percent)

Eurostat, 2006

173%

125%

159%

108%116%

121%128%

132%

143%153%

162%

106% 110%

130%135% 136%

142%147%

105%

100%

110%

153%

117%

132%

143%

154%

167%

183%

200%

216%

233%

120%

110%

121%

100%

120%

140%

160%

180%

200%

220%

240%

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Perc

ent

EU (10 new countries) EU (15 countries) Lithuania

EU countries: average monthly salary in PPS (excluding persons working in agriculture and fishery sectors and in households),

2003

Eurostat, 2006

3479

3030

2335 2320 22432082

1628 1502 1461 14591145 1132 1053

838621 588

0

500

1000

1500

2000

2500

3000

3500

4000U

nite

d K

ingd

om

Icel

and

Spai

n

Cyp

rus

Slov

enia

Mal

ta

Cze

ch R

epub

lic

Hun

gary

Pola

nd

10 N

ew M

embe

r Sta

tes

Esto

nia

Slov

akia

Lith

uani

a

Latv

ia

Bul

garia

Rom

ania

(PPS

)

The projections of the economic indicators in Lithuania for the years 2006–2009 made by the Ministry of Finance of the RoL

(1)

The Ministry of Finance of the RoL. The projections of economic indicators in Lithuania for the years 2006–2009. The projections were published on 28.04.2006.

Basic macroeconomic indicators

Macroeconomic indicators 2005Projections(28.04.2006)

2006 2007 2008 2009

The growth of GDP /Real GDP, in % 7.5 7 5.8 5.8 5.3

The growth of calculated salary * / growth of average gross salary, in % 12.2 8 8.1 8.9 8.8

Calculated salary * / Average gross salary, in LTL 1289.5 1393 1506 1641 1785

Unemployment/ the level of unemployment, in % (according to the workforce study data).

8.3 6.9 6 5.6 5.6

Consumption growth / Real growth, in % 9.4 8.6 5.9 5.7 5.4

Nominal GDP growth, in % 13.8 9.1 9 9.5 9.6

* - quarterly data excluding individual enterprises

The projections of the economic indicators in Lithuania for the years 2006–2009 made by the Ministry of Finance of the

RoL(2)

The Ministry of Finance of the RoL. The projections of economic indicators in Lithuania for the years 2006–2009. The projections were published on 28.04.2006.

7,5 7,05,8 5,8

5,3

13,8

9,1 9,09,5 9,6

12,2

8,0 8,1

8,9 8,88,3

6,9

6,05,6 5,6

4,0

6,0

8,0

10,0

12,0

14,0

2005 2006 2007 2008 2009

Perc

ent

GDP growth/Real GDP growthin percent

Nominal GDPgrowth, in percent

Growth of gross

salary, in percent

Unemployment/the level of

unemployment,

according to the

workforce research data

CONCLUSIONS The percentage of GDP created in Lithuania makes 0.4 percent of total EU

GDP and is the same like in Slovenia, however, according to GDP per capita (in purchasing power standards), Lithuania is one of the last among the EU countries.

During the medium-term period Lithuania will maintain rapid growth of economy: real growth of GDP in 2006 will reach 7 percent and in 2007–2008 – 5.8 percent. In 2009, the growth will decrease to 5.3 percent. Nominal growth in 2006 can amount to 9.1 and during 2007-2009 – from 9 to 9.6 percent.

Although salary in Lithuania is one of the lowest among the EU countries, the growth of calculated salary *(the growth of gross salary), can amount to 8 percent in 2006, to 8.1 percent in 2007 and during the period of 2008-2009 – from 8.8 to 8.9. By 2009 the forecasted unemployment rate should decrease to 5.6 percent.

The forecasted rapid GDP and gross salary growth, also the decrease of unemployment create preconditions to pay more attention to social and health promotion needs of country population.

The Ministry of Finance of RoL. The projections of economic indicators in Lithuania for the years 2006–2009.The projections were published on 28.04.2006..

THE RESOURCES AND FUNCTIONING OF THE HEALTH SYSTEM

The providers of health promotion services*

ŠALIES ŪKISSVEIKATINIMO

PASLAUGŲ TEIKĖJAI

PIRMINIAI** ANTRINIAI***

TARPINIAI SVEIKATINIMO

PASLAUGŲ TEIKĖJAI

Hospitals

Nursing and foster institutions

Outpatient care institutions

Pharmacies and other retail trade

commodities

Administration, insurance

Nursing and fosterinstitutions

in medical commodities

Other

Namų ūkiai

Sveikatos priežiūra darbe

Farmacijos ir biomedicinos

įmonės bei didmenininkai

Medicinos įrangos bei priemonių gamintojai ir

didmenininkai

Kitos įmonės

Country economy

PROVIDERS OF HEALTHPROMOTION SERVICES

PRIMARY** SECONDARY***

INTERMEDIARYPROVIDERS OF

HEALTH CARE SERVICES

in medical

,

Retail trade

Households

Health careat work

Pharmaceutical and bio-medical

companies and wholesalers

Manufacturers of medical appliances and commodities and wholesalers

Other companies

Based on OECD 2000 Methodology of health accounts

* - Based on the Methodology of health accounting. OECD 2000

* * - basic activities: health promotion

*** - basic activities: not health promotion

EU countries: the number of physicians per 100,000 population, 2004

WHO, European health for all database, 2006; Health Information Centre

475

396362 352 348 338 337 335 329 325 322 319 318 316 315 298 295 278 268 261 258

229 226

050

100150200250300350400450500

Gre

ece

Lith

uani

a

EU m

embe

rs b

efor

e M

ay 2

004

Cze

ch R

epub

lic EU

Aus

tria

Ger

man

y

Fran

ce

Port

ugal

Hun

gary

Spai

n

Finl

and

Slov

akia

Esto

nia

Mal

ta

Latv

ia

Den

mar

k

EU m

embe

rs s

ince

May

200

4

Luxe

mbo

urg

Cyp

rus

Irela

nd

Pola

nd

Slov

enia

Num

ber o

f phy

sici

ans

per 1

00,0

00 p

opul

atio

n

The comparison of change in number of physicians in the new EU countries, 1985-2005


150

200

250

300

350

400

45019

85

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005N

umbe

r of p

hysi

cian

s pe

r 100

,000

pop

ulat

ion



EU

EU countries: number of hospital beds * per 100,000 population, 2003

* - excluding patients in nursing homes

WHO, European health for all database, 2006; Health information centre

657 639 630 625 601 593558 554 545 520

485440 419 402 401 400 380 360

327 324 309 296229 223

0

100

200

300

400

500

600

700G

erm

any

Slov

akia

Cze

ch R

epub

lic

Lith

uani

a

Aus

tria

Hun

gary

Euro

pean

Reg

ion

Luxe

mbo

urg

Latv

ia

EU m

embe

rs s

ince

May

200

4

Bel

gium

Esto

nia

EU

Cyp

rus

Slov

enia

EU m

embe

rs b

efor

e M

ay 2

004

Fran

ce

Italy

Mal

ta

Den

mar

k

Port

ugal

Irela

nd

Finl

and

Swed

en

Num

ber o

f bed

s pe

r 100

,000

pop

ulat

ion

Comparison of change in number of hospital beds * per 100,000 population in the new EU countries, 1985-2004

* - excluding patients in nursing homes

WHO, European health for all database, 2006; Health information centre

300

400

500

600

700

800

900

100019

85

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

Num

ber o

f bed

s pe

r 100

,000

pop

ulat

ion


Comparison of change in average duration of hospitalization (in days) in the hospitals of the new EU countries*, 1985-2005

* - excluding nursing homes


5

6

7

8

9

10

11

12

13

14

15

1619

85

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

Ave

rage

dur

atio

n of

hos

pita

lizat

ion


Comparison of change in the number of hospitalizations* in Lithuania with the EU average, 1985-2004

•- excluding nursing homes


10

12

14

16

18

20

22

2419

85

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

Num

ber o

f hos

pita

lizat

ions

per

100

pop

ulat

ion


Number of hospitalizations according to separate groups of diseases in Lithuania, as percentage of the EU average, 2003

2005, OECD Health data; Health Information Centre

Comparison was made with the data of the following countries included into OECD database: Ireland, Denmark, Italy, United Kingdom, Luxembourg, the Netherlands, Portugal, Finland

43%

108%

114%

115%

122%

123%

136%

140%

141%

160%

198%

208%

276%

0% 50% 100% 150% 200% 250% 300%

Diseases of the blood, 2003

Diseases of the musculoskeletal system, 2003

Diseases of the nervous system, 2003

Diseases of the digestive system, 2003

Endocrine, nutritional and metabolic diseases, 2003

Malignant neoplasms, 2003

All causes, 2003

Diseases of the skin and subcutaneous tissue, 2003

Diseases of the genito-urinary system, 2003

External causes, 2003

Diseases of the respiratory system, 2003

Diseases of the circulatory system, 2003

Infectious and parasitic diseases, 2003

Number of hospitalizations according to separate groups of diseases in Lithuania, as an average percentage of the

Western European countries, 2000 and 2003

2005, OECD Health data; Health Information Centre

43%

36%

108%

148%

114%

94%

115%

125%

122%

160%

123%

143%

136%

141%

140%

133%

141%

174%

160%

165%

198%

156%

208%

237%

276%

228%

0% 50% 100% 150% 200% 250% 300%













All causes, 2003

All causes, 2000













*Comparison was made with the data of the following countries included into OECD database: Ireland, Denmark, Italy, United Kingdom, Luxembourg, the Netherlands, Portugal, Finland

EU countries: the number of out-patient visits to physicians per capita per year, 2003

2005, OECD Health Data; Health Information Centre

13,012,4 12,2

9,58,9

7,36,7 6,4 6,3 6,1 6,0

5,24,2

3,73,2

0,0

2,0

4,0

6,0

8,0

10,0

12,0

14,0

Cze

ch R

epub

lic

Slov

ak R

epub

lic

Hun

gary

Spai

n

Uni

ted

Stat

es

Den

mar

k

Aus

tria

Lith

uani

a

Luxe

mbo

urg

Pola

nd

Aus

tral

ia

Unite

dKi

ngdo

m

Finl

and

Portu

gal

New

Zea

land

CONCLUSIONS

The number of physicians and hospital beds per 100.000 citizens is one of the highest in EU.

The number of hospitalizations in Lithuania compared to the EU average is more than by 30 percent higher and the average duration of treatment in hospitals remains fairly long.

The number of outpatient consultations by physicians is close to the EU average.

Considering the aforementioned indicators it is necessary to further improve the accessibility of effective outpatient treatment and at the same time to modernise and restructure the network of hospitals, also to more efficiently use human and material resources of health sector.

THE FINANCING OF HEALTH PROMOTION IN LITHUANIA

National health accounts The expenditures of health promotion activities

Health promotion activities expenditures include health care services providers’ capital formation expenditures and expenditures for health care services and commodities of the national companies, institutions and private persons (including administration and insurance).

These expenditures do not include the export of health care services (services provided by local service providers to foreigners); however, they include the import of such services (health care services for persons travelling abroad).

Based on OECD 2000 Methodology on health accounting

National health accounts. Classification of health promotion activities according to

functions

Based on OECD 2000 Methodology on health accounting, it is recommended to attribute the following services and functions

to the health promotion expenditures:

Personal health care services and commodities (therapeutic, rehabilitation, nursing, auxiliary services and medical commodities )

Collective health care services (prevention and society health, administration and insurance of health system)

Functions related to health care (the capital formation of health care companies, education and training of personnel, scientific research, control of food, hygiene and water, environment health, administration of money and payments.

Based on OECD 2000 Methodology on health accounting

National health accounts. The financing resources of health promotion activities

Based on OECD 2000 Methodology on Health Accounting

State budget Municipality budgets The system of Compulsory Health Insurance Fund

(CHIF) Other (structural funds, subsidies, tax exemptions and

other) Households (direct and unofficial payments) Complementary health insurance Other (expenditures of employers, charity, foreign aid

and other)

The structure of the financing of health promotion activities

Health Economy Centre, 2006

STATE BUDGET

BUDGET OF THE MINISTRY OF HEALTH

MUNICIPALITY BUDGETS

COMPULSORY HEALTH INSURANCE FUND

PRIMARY HEALTH CARE

IN-PATIENT HEALTH CARE

OUT-PATIENT SPECIALIZED HEALTH

CARE

PHARMACEUTICALS AND MEDICAL COMMODITIES

AG

REE

MEN

TS

INVESTMENTS

EXTRA PAYMENTS AND DIRECT PAYMENTS

HEALTH INSURANCE CONTRIBUTIONS

TAXE

S

SPECIALIZED BUDGETARY

INSTITUTIONS

POPULATION

EMPLOYERS

PATIENTS

EMPLOYERS

SERVICE PROVIDERS (PUBLIC AND PRIVATE INSTITUTIONS)

PART OF INDIVIDUAL INCOME TAX

BUDGETS OF MINISTRY OF NATIONAL DEFENCE AND MINISTRY OF THE

INTERIOR

ACCORDING TO THE NUMBER OF

REGISTERED POPULATION

ACCORDING TO THE PROFILES OF DISEASES

FOR CONSULTATION

REIMBURSEMENT

CONTRIBUTIONS FOR INSURED

COVERED BY THE STATE

BUDGETARY HEALTH CARE

SYSTEM INSTITUTIONS

CU

RR

ENT

EXPE

ND

ITU

RES

NON-LIFE AND SUPPLEMENTA-RY INSURANCE

TAX EXEMPTIONS

OTHER INSTITUTIONS

National health accounts. Table of public and private expenditures for health promotion, mil.

LTL

SPF data, Department of Statistics under the Government of the Republic of Lithuania

Calculations of the Health Economy Centre

Public financing of the health system in Lithuania2004 2005

Expenditures of CHIF budget, mil. LTL 2094.7 2453.9Expenditures of the State and municipal budgets for health promotion activities, mil. LTL 346.7 427.8

Total public expenditures, mil. LTL 2441.3 2881.6Financing of the Lithuanian health system from private resources

2004 2005

Expenditures of households, mil. LTL 1108.2 1224.9

Expenditures of employers (companies) for health care, mil. LTL 73.0 74.5

Total private expenditures, mil. LTL 1181.2 1299.3

Total expenditures for the financing of the health system, mil. LTL 3622.6 4181.0

Percentage of total expenditures of GDP 5.8% 5.9%Percentage of private expenditures for the financing of the health system 32.6% 31.1%

EU countries: public and private expenditures for health promotion, as percentage of GDP, 2003

* - Data of 2002

WHO, European health for all database, 2006; Department of Statistics under the Government of the Republic of Lithuania

11,110,1 9,9 9,8 9,6 9,6 9,3 9,2 9,2 9,0 8,8 8,8 8,4

7,8 7,7 7,7 7,5 7,4 7,3 7,36,5 6,3 6,1 6,0 5,9 5,8

5,3 5,0

0,0

2,0

4,0

6,0

8,0

10,0

12,0

Ger

man

y

Fran

ce

Gre

ece

Net

herla

nds

Bel

gium

Port

ugal

Mal

ta

EU m

embe

rs b

efor

e M

ay 2

004

Swed

en*

Den

mar

k EU

Slov

enia

Italy

Hun

gary

*

Spai

n

Uni

ted

Kin

gdom

*

Aus

tria

Finl

and

Cze

ch R

epub

lic

Irela

nd*

EU m

embe

rs s

ince

May

200

4

Cyp

rus

Luxe

mbo

urg*

Pola

nd*

Slov

akia

Lith

uani

a

Esto

nia

Latv

ia

Perc

enta

ge

EU countries: public and private expenditures for health promotion, as percentage of GDP, 2003

2005, OECD Health Data; WHO, European health for all database, 2006, SPF data, Department of Statistics under the Government of the Republic of Lithuania

8,7%7,7% 7,5% 7,4% 7,0% 6,9% 6,7% 6,7% 6,3% 6,1% 5,7% 5,5% 5,2% 5,1% 5,1%

4,0% 3,9% 3,3% 3,2%

2,4%

2,4%1,5% 1,8% 2,6%

1,9% 2,9%

0,6%2,1%

3,7%

1,7% 2,2%

0,7%

4,8%

2,4%

1,3% 1,9%1,7%

3,1%

0,0%

2,0%

4,0%

6,0%

8,0%

10,0%

12,0%G

erm

any

Fran

ce

Den

mar

k

Mal

ta

Bel

gium

Slov

enia

Port

ugal

Cze

ch R

epub

lic

Italy

Net

herla

nds

Finl

and

Spai

n

Slov

akia

Gre

ece

Aus

tria

Esto

nia

Lith

uani

a

Latv

ia

Cyp

rus

Public expenditures Private expenditures

EU countries: public and private expenditures for health promotion in USD, 2003

4031

34543120 3014 2934 2894

2666 25402222

1482 1467 1329

661 632344 339 312

22152025

0

500

1000

1500

2000

2500

3000

3500

4000

4500Lu

xem

bour

g

Den

mar

k

Ger

man

y

Swed

en

Net

herla

nds

Fran

ce

Bel

gium

Irela

nd

Finl

and

Aus

tria

Italy

Spai

n

Gre

ece

Port

ugal

Hun

gary

Cze

ch R

epub

lic

Slov

ak R

epub

lic

Pola

nd

Lith

uani

a

2005, OECD Health Data; WHO, SPF data, Department of Statistics under the Government of the Republic of Lithuania

Public financing of health system in Lithuania

The structure of health care system public financing in Lithuania, 2005

85%

15%

CHIF expendituresfor healthpromotion

Expendituresof the State and

municipal budgetsfor healthpromotion

Expenditures from the State and municipal budgets for health promotion include: the expenditures of the Ministry of Health, Ministry of National Defense, Ministry of the Interior, Ministry of Justice, expenditures of State Investment Fund and structural funds as well as the expenditures of the Institute of Forensic Medicine, Kaunas University of Medicine, Institute of Immunology of Vilnius University and Lithuanian Library of Medicine.

Lithuanian GDP and public expenditures for health promotion (in billion LTL), 2000-2006

* - plan


45,5 48,651,9

56,862,4

71,177,6

3,332,882,442,232,092,032,010,0

10,0

20,0

30,0

40,0

50,0

60,0

70,0

80,0

90,0

2000 2001 2002 2003 2004 2005 2006*

Bill

ion

litas

GDP in Lithuania (according to actual prices), billion LTLPublic expenditures for health care, in billion LTL

Public expenditures for health promotion, as percentage of GDP, 2000-2006

* - plan


4,42%

4,19%4,05%

3,93% 3,91%4,05%

4,30%

3,6%

3,8%

4,0%

4,2%

4,4%

4,6%

2000 2001 2002 2003 2004 2005 2006*

Perc

enta

ge o

f GD

P

EU countries: Public expenditures for health promotion, as percentage of GDP, 2003

2005, OECD Health Data


8,7%

7,7% 7,5% 7,4%7,0% 6,9% 6,7% 6,7% 6,3% 6,1%

5,7% 5,5% 5,2% 5,1% 5,1%

4,0% 3,9%3,3% 3,2%

0,0%

1,0%

2,0%

3,0%

4,0%

5,0%

6,0%

7,0%

8,0%

9,0%

10,0%

Ger

man

y

Fran

ce

Den

mar

k

Mal

ta

Belg

ium

Slov

enia

Port

ugal

Czec

h R

epub

lic

Italy

Neth

erla

nds

Finl

and

Spai

n

Slov

akia

Gre

ece

Aus

tria

Esto

nia

Lith

uani

a

Latv

ia

Cypr

us

EU countries: Public expenditures for health promotion as percentage of all expenditures for health care, 2003

WHO, European health for all database, 2006; Department of Statistics under the Government of the Republic of Lithuania

91,4 88,383,0 80,1 78,8 78,2 76,5 76,3 75,5 75,1 73,2 71,2 69,7 67,6 66,7 65,7

62,4

51,3 50,5

0,010,020,030,040,050,060,070,080,090,0

100,0

Cze

ch R

epub

lic

Slov

akia

Den

mar

k

Mal

ta

Slov

enia

Ger

man

y

Finl

and

Fran

ce

Esto

nia

Italy

Bel

gium

Spai

n

Port

ugal

Aus

tria

Lith

uani

a

Latv

ia

Net

herla

nds

Gre

ece

Cyp

rus

Perc

enta

ge

EU countries: Public expenditures for health promotion per capita in USD, 2003

2005, OECD Health Data, SPF dataHealth Economy Centre, calculated according to the rate of exchange of USD/LTL of 2003

3700

2932

26842506

2263 2184

19261758

1607 1595

1092940

794602

495318 248 211

0

500

1000

1500

2000

2500

3000

3500

4000

Luxe

mbo

urg

Den

mar

k

Swed

en

Ger

man

y

Fran

ce

Irela

nd

Net

herla

nds

Finl

and

Italy

Aus

tria

Spai

n

Port

ugal

Gre

ece

Cze

ch R

epub

lic

Hun

gary

Slov

ak R

epub

lic

Pola

nd

Lith

uani

a

US

dolla

rs

EU countries: comparison of expenditures for health promotion, 2003

2005, OECD Health Data, SPF dataHealth Economy Centre, calculated according to the rate of exchange of USD/LTL of 2003.

940

1926

794

22632506

318

211248

1758

1595

495

2932

2684

3700 602

40

50

60

70

80

90

100

5 6 7 8 9 10 11 12Percentage of GDP of total expenditures for health care

Perc

enta

ge o

f pub

lic e

xpen

ditu

res

into

tal e

xpen

ditu

res

for h

ealth

car

e

Lithuania

Luxembourg

Denmark

Germany

Sweden

Netherlands

France

Austria

Greece

HungaryPortugal

FinlandSlovak Republic

Czech Republic

Poland

The size of the circle shows public expenditures for health promotion per capita

in US dollars

Income and expenditures of the Compulsory Health Insurance Fund

(CHIF)

Income of the Lithuanian CHIF

Compulsory health insurance contributions from companies, institutions and organizations and from self-employed persons (3 percent of salary)

Deductions of individual income tax from companies, institutions and organizations and from self-employed persons

Compulsory health insurance contributions from farmers and users of personal farm for themselves and adult family members working in the farm

Compulsory health insurance contributions from persons who pay contributions for themselves amounting to 10 percent of average salary

Contributions and subsidies from the State budget of the Republic of Lithuania, including State budget contributions for the insured covered by the State, compensations to blood donors, budget subsidies for orthopedic commodities, supplementary subsidies from the State budget

Operational revenue of institutions implementing compulsory health insurance

Voluntary contributions from legal entities and private individuals Surcharged financial means for damage made to the budget of the

Compulsory Health Insurance Fund

Income of the CHIF budget (excluding the balance for the beginning of the year),

2000 – 2006

* - plan

SPF data

1,86 1,87 1,872,03

2,34

2,87

1,892,08

2,24

2,61

1,811,841,81

0,00

0,50

1,00

1,50

2,00

2,50

3,00

3,50

2000 2001 2002 2003 2004 2005 2006*

Bill

ion

litas

CHIF income (planned), billion LTL CHIF income (actual), billion LTL

8724 927610572

11360

13815

16490

18933

4405 4438 4570 48865564

6391 6793

1806 1838 1894 2075 2243 2611 2865

02000400060008000

100001200014000160001800020000

2000 2001 2002 2003 2004 2005 2006*

Bill

ion

LTL

Income of the State budget and municipal budgetsIncome of the State Social Insurance Fund Board budgetIncome of CHIF budget

The change of the income of funds from which health promotion activities in Lithuania are financed (mil. LTL), 2000-2006

Growth of the income of CHIF budget

2000 - 2005 – 144.5 %

Growth of the income of the National budget 2000 - 2005 - 189 %

SPF dataDepartment of Statistics under the Government of the Republic of Lithuania

Growth of the income of SSIFB budget

2000 - 2005 – 145 %

The change of the income of funds from which health promotion activities in Lithuania are financed, in percentage, 2000-2006

SPF data

Department of Statistics under the Government of the Republic of Lithuania

6,3%

14,0%

21,6%19,4%

14,8%

13,9% 14,9% 6,3%

7,5%

0,7%6,9%3,0%

9,6%8,1%

9,8%

1,8% 3,1%

16,4%

0,0%

5,0%

10,0%

15,0%

20,0%

25,0%

2000 2001 2002 2003 2004 2005 2006*

Perc

enta

ge

The change of the income of the State budget and municipal budgets, %.Income of the State Social Insurance Fund Board budget (change), % .Income of CHIF budget (change), % .

The change of the income of funds from which health promotion activities in Lithuania are financed (mil. LTL), 2000-2006

SPF data

Department of Statistics under the Government of the Republic of Lithuania

552

1296

788

24552675

2444

33 132316

678826

403168

368 2551815632

0

500

1000

1500

2000

2500

3000

2000 2001 2002 2003 2004 2005 2006*

Bill

ion

litas

The change of the income of the State budget and municipal budgetsIncome of the State Social Insurance Fund Board budget (change)Income of CHIF budget (change)

The structure of the CHIF budget, 2005

SPF data

18%

48%

24%10%

Compulsory health insurance contributions from companies, institutions and organizations and self-employed personsDeductions of individual income tax from companies, institutionsand organizations and self-employed personsContributions and subsidies from the State budget of the Republic of Lithuania

Other

Contribution from the State budget for one insured covered by the State increased to LTL 304.4 per year About 58.6 percent of population is covered by the StateSPF data

Contribution from the State budget to the CHIF per oneinsured person covered by the State

188 187 198221,4

264,2

304,4

0

100

200

300

400

2001 2002 2003 2004 2005 2006

Mill

ion

litas

-0,5

%

5,9

%

11,8

% 19,3

% 15,2

%

Contribution from the State budget to the CHIF per one insured covered from the State budget (1)

Contribution from the State budget per one insured covered from the State budget (2)

Article 16. Contributions from the State budget to the budget of the Compulsory Health Insurance Fund

1. Each year when approving the State budget, the Parliament approves contribution amount to the Compulsory Health Insurance fund for one insured covered by the State.

2. Contribution amount covered by the State established in part 1 of this Article makes 35 percent of individual’s income as approved by the order of State Social Insurance Law. This amount will be reached by the year 2009.

Amendments of the Article:No. IX-1901, 16-12-2003, “Valstybes Žinios”, 2003, No. 123-5580 (30-12-2003)

LAW ON HEALTH INSURANCE OF THE REPUBLIC OF LITHUANIA21 May 1996, No. I-1343New version from 1 January 2003:No. IX-1219, 03-12-2002, “Valstybes Žinios”, 2002, No. 123-5512 (24-12-2002)

Contribution from the State budget per one insured covered from the State budget (3)

INSURED INCOME (IN LITAS), APPLIED FOR RATIO CALCULATION OF INSURED INCOME FROM 1995

(State Social Insurance Fund Board under the Ministry of Social Security and Labour)

From 1 July 2003 average monthly insured income is LTL 901.

35 percent of the insured income of 2003 – 315.35 litas

Average insured income (in litas) applied for ratio calculation of insured income in 2005 was 1037 litas,

from 1 July 2006 – 1212 litas

Comparison of contribution of one employed person and the State budget contribution for one insured covered by the State per year,

2000-2005

Compulsory health insurance contributions from farmers and users of personal farm for themselves and adult family members who work in the farm and compulsory health insurance contributions from persons who pay contributions for themselves amounting to 10 percent of average salary made 0.09 percent of total CHIF income in 2005. Department of Statistics under the Government of the Republic of Lithuania, SPF data

9541030

1124 11861322

1452

202 188 187 198 221 264

0

400

800

1200

1600

2000 2001 2002 2003 2004 2005

In li

tas

Contributions to CHIF per one employed person, in litasthe State budget contribution per one insured covered by the State

Expenditures of the CHIF budget

Expenditures for primary, secondary and tertiary personal health care;

Expenditures for reimbursement of acquisition of drugs and medical commodities;

Expenditures for compensation of medical rehabilitation and treatment in sanatoriums;

Expenditures for prosthesis of limbs, joints and organs, for acquisition of prostheses and for centralized acquisition of pharmaceuticals and medical commodities;

Expenditures for acquisition of orthopaedic commodities; Expenditures for financing of health programs; Expenditures for treatment of the EU citizens in Lithuanian personal

health care facilities; Operational expenses of institutions implementing compulsory health

insurance; CHIF budget reserve expenses.

Expenditures of the CHIF budget (in mil. litas), 2000 – 2006

SPF data

18931957

2113

2513

18371937

1848 1902

2095

2454184618311869

1789

2885

1500

1700

1900

2100

2300

2500

2700

2900

1998 1999 2000 2001 2002 2003 2004 2005 2006*

Mill

ion

litas

CHIF expenditures (cash) CHIF expenditures (presented for payment) CHIF expenditures (planned)

9468 9988

1167312490

14560

17063

18933

4581 4451 4461 47035326

61306793

1789 1846 1893 1957 2113 2513 2865

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

2000 2001 2002 2003 2004 2005 2006*

Mill

ion

litas

Expenditures of the State budget and municipal budgetsExpenditures of the State Social Insurance Fund BoardExpenditures of the CHIF budget

The expenditures change of funds from which finance health promotion activities in Lithuania (mil. LTL), 2000-2006

SPF data; Department of Statistics under the Government of the Republic of Lithuania

Growth of the expenses of CHIF budget

2000 - 2005 – 140.4 %

Growth of the expenses of the National budget

2000 - 2005 - 180.2 %

Growth of the expenses of SSIFB

2000 - 2005 – 133.8 %

The expenditures change of funds from which finance health promotion activities in Lithuania, in percentage, 2000-2006


520

1685

817

2071

2502

1870

10242

623803

664

156400 352

-129

57 47 63

-500

0

500

1000

1500

2000

2500

3000

2000 2001 2002 2003 2004 2005 2006*

Mill

ion

litas

Change of the expenditures of the State budget and municipal budgetsExpenditures of the State Social Insurance Fund Board (change)Expenditures of the CHIF budget (change)

The expenditures change of funds which finance health promotion activities in Lithuania (mil. LTL), 2000-2006


5,5%

13,3% 15,1% 10,8%

7,0%

11,0%

17,2%16,6%16,9%

0,2%5,4%

-2,8%

3,4%

8,0%

14,0%

18,9%

2,6%3,2%

-3,0%

2,0%

7,0%

12,0%

17,0%

22,0%

2000 2001 2002 2003 2004 2005 2006*

Perc

enta

ge

Change of the expenditures of the State budget and municipal budgets, %

Expenditures of the State Social Insurance Fund Board (change), %

)Expenditures of the CHIF budget (change), %

Income and expenditures of the CHIF (in billion LTL), 2000-2005

SPF data

1,81 1,84 1,892,08

2,24

2,61

1,79 1,85 1,89 1,96 2,112,51

0,00

0,50

1,00

1,50

2,00

2,50

2000 2001 2002 2003 2004 2005

Bill

ion

litas

CHIF income (actual), billion LTL CHIF expenditures (actual), billion LTL

Total expenditures (actual, presented for payment) – 12.11 billion LTL

Total income (actual) – 12.47 billion litas

The CHIF budget structure, 2005

SPF data

67,6%19,7%

3,6%1,0% 1,0%2,9%0,2%

3,9%

Expenditures for personal health care services

Expenditures for reimbursement of acquisition of pharmaceuticals and medical commodities

Expenditures for reimbursement of medical rehabilitation and treatment in sanatoriums

Expenditures for the prosthesis of limbs, joints and organs, for acquisition of prostheses and centralized acquisition of pharmaceuticals and medical commoditiesExpenditures for reimbursement of acquisition of orthopedic commoditiesExpenditures for financing of health programs

Operational expences of institutions implementing compulsory health insurance

Other expenditures

The CHIF budget expenditures for personal health care services (in billion litas )

SPF data

1,461,37 1,37

1,32 1,341,39

1,52

1,89

1,39 1,481,36 1,37 1,32 1,34 1,42

1,661,51

1,40 1,36 1,33 1,36 1,32 1,34

1,47

1,67

0,80

1,00

1,20

1,40

1,60

1,80

2,00

1998 1999 2000 2001 2002 2003 2004 2005 2006plan

Bill

ion

litas

CHIF expenditures for personal health care services (planned), billion LTL.

CHIF expenditures for personal health care services (presented for payment), billion LTL.CHIF expenditures for personal health care services (cash expenditures), billion LTL.

EU countries: current public expenditures for in-patient health care per capita in USD, 2003

•** - Including expenditures for in-patient nursing, rehabilitation and treatment in sanatoriums

2005, OECD Health Data, 2003, SPF data calculated according to USD/LTL rate of exchange of 2003

1181 11261021

766711 659

336

20298 86

0

200

400

600

800

1000

1200

1400

Luxe

mbo

urg

Den

mar

k

Fran

ce

Ger

man

y

Net

herla

nds

Finl

and

Spai

n

Cze

chR

epub

lic

Pola

nd

Lith

uani

a

US

dolla

rs

EU countries: current public expenditures for in-patient health care in percentage of total current public health care

expenditures, 2003

•* - Hungary, 2002•** - Including in-patient nursing, rehabilitation and sanatorium treatment services2005, OECD Health Data, 2003, SPF data

59,054,1

51,7 50,1 50,0 47,843,9 43,2

40,4 38,8 38,4 38,1 37,8 36,2 34,3

0

10

20

30

40

50

60

70D

enm

ark

Italy

Fran

ce

Finl

and

Net

herla

nds

Lith

uani

a

Aus

tria

Pola

nd

Luxe

mbo

urg

Hun

gary

*

Swed

en

Ger

man

y

Cze

chR

epub

lic

Slov

akR

epub

lic

Spai

n

EU countries: current public expenditures for out-patient health care per capita in USD, 2003

•- including individual income tax expenditures

2005, OECD Health Data, 2003, SPF data calculated according to USD/LTL rate of exchange of 2003

1277

821 814

514 501 465 445 438 388 379444949

180

0

200

400

600

800

1000

1200

1400

Swed

en

Luxe

mbo

urg

Den

mar

k

Ger

man

y

Finl

and

Italy

Fran

ce

Aus

tria

Net

herla

nds

Spai

n

Cze

ch R

epub

lic

Pola

nd

Lith

uani

a

Slov

ak R

epub

lic

US

dolla

rs

EU countries: current public expenditures for out-patient health care in percentage of total current public health care expenditures,

2003

•- Hungary, 2002

2005, OECD Health Data; SPF data

42,4

28,5 27,125,6

23,6 23,0 22,520,4 19,8

16,5 15,4 14,5 13,2 12,8 12,0

0,0

5,0

10,0

15,0

20,0

25,0

30,0

35,0

40,0

45,0Sw

eden

Cze

chR

epub

lic

Lith

uani

a

Spai

n

Den

mar

k

Italy

Finl

and

Luxe

mbo

urg

Aus

tria

Ger

man

y

Fran

ce

Pola

nd

Net

herl

ands

Slov

akR

epub

lic

Hun

gary

*

Ratio comparison in percentage of personal health care expenditures in Lithuania and average personal health care expenditures in the

Western European countries, 2000 and 2003

Comparison was made using the data of the following countries available in OECD database: Germany, France, Spain, the Netherlands, Denmark, Finland, Luxembourg

2005, OECD Health Data; Health Information CentreCalculations of Health Economy Centre

11,0%

11,7%

10,5%

10,9%

11,4%

12,2%

5% 6% 7% 8% 9% 10% 11% 12% 13%

Total expenditures, 2003

Total expenditures, 2000

Out-patient expenditures,2003

Out-patient expenditures,2000

In-patient exenditures,2003

In-patient exenditures,2000

Income and expenditures of CHIF for reimbursed pharmaceuticals (mil. LTL), 2000-2006

2006* - plan

* - including centralized purchases of pharmaceuticalsSPF data

321 432 364 381 420 484 507

1806 1838 18942075

2243

26112865

0

500

1.000

1.500

2.000

2.500

3.000

3.500

2000 2001 2002 2003 2004 2005 2006*

Mill

ion

litas

Expenditures of the State Patient Fund for reimbursement of pharmaceuticals (presented for payment)

CHIF income (actual)

Change of CHIF income and expenditures for reimbursed pharmaceuticals (in mil. LTL), 2000-2006

2006* - plan


111

-68

1739

64

233256

181 168

368

255

-100

-50

0

50

100

150

200

250

300

350

400

2001 2002 2003 2004 2005 2006*

Expenditures of CHIF for reimbursement of pharmaceuticals (presented for payment), mil. LTLCHIF income (change), mil. LTL

The comparison of actual CHIF budget expenditures for reimbursement of pharmaceuticals with planned expenditures, (in

mil. litas) *


In 2001 centralized purchases of pharmaceuticals amounted to 45.8 mil. LTL; In 2002 72 mil. LTL were borrowed from the bank

In 2003 95 mil. LTL were borrowed from the bank; in 2005 55 mil. LTL were assigned from the reserve

322 320 309 309 326 343370

440

507

324355

321

432

364381

420

484

200

250

300

350

400

450

500

550

1998 1999 2000 2001 2002 2003 2004 2005 2006planed

Mill

ion

litas

CHIF budget expenditures (planned) for reimbursement of pharmaceuticals, mil. LTL CHIF budget expenditures (actual) for reimbursement of pharmaceuticals, mil. LTL

.

CHIF expenditures for reimbursed pharmaceuticals (in mil. LTL), 2000-2006

SPF data

321

432

364381

420

484

307348

409 440390

495

0,00

100,00

200,00

300,00

400,00

500,00

2000 2001 2002 2003 2004 2005

Mill

ion

litas

CHIF expenditures for reimbursement of pharmaceuticals, mil. LTL (presented for payment)CHIF expenditures for reimbursement of pharmaceuticals, mil. LTL (in cash)

Total expenditures (presented for payment) – 2.40 billion LTL

Total expenditures (in cash) – 2.39 billion litas

CHIF expenditures for reimbursed pharmaceuticals for out-patient treatment in Lithuania, as percentage of total public expenditures

for health care, 2000-2006

IMS Health, 2005; SPF data

16,0%

21,3%

17,4% 17,1% 17,2% 16,8%15,2%

0,0%

5,0%

10,0%

15,0%

20,0%

25,0%

2000 2001 2002 2003 2004 2005 2006*

Perc

enta

ge

EU countries: expenditures for reimbursed pharmaceuticals as percentage of total public expenditures for health care, 2003

* - Data of Hungary 2002


36,0

24,623,1 22,6

18,6 18,4 17,5 17,114,4 13,9 13,1

11,2 10,5 10,2 9,7

5,8

0

5

10

15

20

25

30

35

40Sl

ovak

Rep

ublic

Hun

gary

*

Gre

ece

Spai

n

Cze

ch R

epub

lic

Fran

ce

Pola

nd

Lith

uani

a

Italy

Ger

man

y

Irela

nd

Finl

and

Net

herla

nds

Swed

en

Luxe

mbo

urg

Den

mar

k

Perc

enta

ge

The major portion of the CHIF budget is spent for out-patient treatment of the following diseases using reimbursed

pharmaceuticals

Diseases

CHIF expendit

ures 2004, mil.

LTL

CHIF expendi

tures 2005,

mil. LTL

Change in %

Oncology and oncohaematology diseases 58.8 63.4 7.8Diabetes 37.8 45.4 20.1Schizofrenia. Schizoaffective disorders 28.3 36.3 28.3

Severe and moderate affective disorders 10.3 11.3 9.7Epilepsy 15 16.5 10.0Glaucoma 11.6 14.5 25.0Hypertenzy diseases 81 100 23.5Asthma 28 33.6 20.0Chronic obstructive lung disease 7.9 11.2 41.8For dialyzed patients and after kidney

transplantation 18 20.7 15.0Total 296.7 352.9 18.9

SPF data

CHIF expenditures for reimbursed pharmaceuticals for out-patient treatment in Lithuania, per capita, according to municipalities (in

LTL), 2005 (1)

SPF data

7580 83 87

95 96 97 97 97 101 102 105 107111 111 112 114 117 117 117 118 119 121 122 122 122 123 124 125 126

0

20

40

60

80

100

120

140

Šalč

inin

kų r

. sav

.

Bir

šton

as

Pagė

gių

sav.

Aly

taus

r. s

av.

Lazd

ijų

r. s

av.

Viln

iaus

r.

sav.

Rie

tavo

sav

.

Trak

ų r.

sav

.

Visa

gina

s

Igna

linos

r. s

av.

Kla

ipėd

os r

. sav

.

Šiau

lių

r. s

av.

Kai

šiad

orių

r. s

av.

Šila

lės

r. s

av.

Skuo

do r

. sa

v.

Joni

škio

r. s

av.

Ner

inga

Kėd

aini

ų r.

sav

.

Jon

avos

r. s

av.

Jurb

arko

r. s

av.

Varė

nos

r. s

av.

Kre

tingo

s r.

sav

.

Kaz

lų R

ūdos

sav

.

Rad

viliš

kio

r. s

av.

Pakr

uojo

r. s

av.

Mol

ėtų

r. s

av.

Bir

žų r

. sav

.

Kal

vari

jos

sav.

Pas

valio

r. s

av.

Any

kšči

ų r.

sav

.

CHIF expenditures for reimbursed pharmaceuticals for out-patient treatment in Lithuania, per capita, according to municipalities (in

LTL), 2005 (2)

SPF data

129 129 130 130 130 131 131 131 131 132 133 133 137 138 139 140 140 141 146 146 149 150 151 151 153 157 160 166

183192 195

0

50

100

150

200

250

Dru

skin

inka

i

Ras

eini

ų r.

sav.

Vilk

aviš

kio

r. sa

v.

Šilu

tės

r. sa

v.

Šven

čion

ių r.

sav

.

Plun

gės

r. sa

v.

Zara

sų r.

sav

.

Mar

ijam

polė

Elek

trėn

ų sa

v.

Maž

eiki

ų r.

sav.

Pane

vėži

o r.

sav.

Kel

mės

r. s

av.

Šaki

ų r.

sav.

Kup

iški

o r.

sav.

Telš

ių r.

sav

.

Kau

no r.

sav

.

Vidu

rkis

Prie

nų r.

sav

.

Akm

enės

r. s

av.

Ukm

ergė

s r.

sav.

Širv

intų

r. s

av.

Taur

agės

r. s

av.

Rok

iški

o r.

sav.

Viln

ius

Kla

ipėd

a

Ute

nos

r. sa

v.

Kau

nas

Aly

tus

Pane

vėžy

s

Šiau

liai

Pala

nga

Financing of health system of Lithuania from private resources

Private expenditures structure for health care (summary table)

Financing of health system of Lithuania from private resources2004 2005

Expenditures of households* (according to the research of households performed by the Department of Statistics), mil. litas 1108.2 1224.9

Expenditures of households (according to calculations made by the Health Economy Centre), in mil. litas, including: 1166.8 1333.1

Expenditures for pharmaceuticals, mil. litas 802.7 939.4Unofficial payments, mil. litas 103.4 108.4

Contributions for supplementary health insurance, accident and sickness insurance, mil. LTL 22.4 23.3Direct payments for personal health care services (including odontology and rehabilitation

services), mil. litas 201.0 223.1

Expenditures for acquisition of glasses, prostheses and orthopedic commodities, mil. litas 37.4 38.9

Expenditures of employers (companies) for health care, mil. litas 73.0 74.5Total private expenditures designated for financing of the health system (household expenditures according to the data of the Department of Statistics), mil. litas 1181.2 1299.4

Total private expenditures for the financing of the health care system (according to calculations of the Health Economy Centre), mil. litas 1239.8 1407.6

* - Department of Statistics under the Government of the Republic of Lithuania. Results of the research of household budgets in 1996 - 2005.

The structure of household expenditures*, 2005

* - Department of Statistics under the Government of the Republic of Lithuania. Results of the research of household budgets in 1996 - 2005.

76,7%

8,9%14,5%

Household expenditures for pharmaceuticals

Unofficialpayments

Other expendituresfor health servicesand commodities

The research of households. The expenditures of Lithuanian population for health care, mil. LTL, 1996-2005

© Department of Statistics under the Government of the Republic of Lithuania. Results of the research of household budgets in 1996 - 2005.

Year Total expenditures per month, in litas

Number of population

Total expenditures for health, mil. LTL.

1996 9.2 3615200 399.11997 11.8 3588000 508.11998 14.8 3562300 632.71999 15.3 3536400 649.32000 17.9 3512100 754.42001 18.7 3487000 782.52002 23.3 3475600 971.82003 24.1 3462500 1001.42004 26.8 3445900 1108.22005 29.8 3425300 1224.9

The research of households. The expenditures per one household member for health care in Lithuania, mil. LTL, 1996-

2005


110

142

178166

194208

227 227240

270

0

50

100

150

200

250

300

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Lita

s

Expenditures for health care per year, per capita, in litasLinear (expenditures for health care per year, per capita, in litas)

The research of households. The expenditures of Lithuanian population for health care, mil. LTL, 1996-2005


399,1508,1

632,7 649,3754,4 782,5

971,8 1001,41108,2

1224,9

0

400

800

1200

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Total expenditures for health, mil. LTL Linear (total expenditures for health, mil. LTL)

The research of households. The expenditures of Lithuanian population for health care as percentage of total household

expenditures, 1996-2005

In 2005 total household expenditures for health care increased by 89 percent compared to 1999


3,6%4,4% 4,6% 4,8% 4,9% 5,2% 5,2%

0,0%

1,0%

2,0%

3,0%

4,0%

5,0%

6,0%

1999 2000 2001 2002 2003 2004 2005

Perc

enta

ge

The research of households. The expenditures of Lithuanian population for health care and pharmaceuticals, mil. LTL, 2002-

2005


622,7689,4

803,0

939,4971,8 1001,41108,2

1224,9

0,0

200,0

400,0

600,0

800,0

1.000,0

1.200,0

1.400,0

2002 2003 2004 2005

Expenditures of population for pharmaceuticals, mil. LTL Household expenditures for health care, mil. LTL

The research of households. The expenditures of Lithuanian population for pharmaceuticals, as percentage of total household

expenditures for health care, 2002 - 2005


64,1% 68,8% 72,5% 76,7%

35,9% 31,2% 27,5% 23,3%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2002 2003 2004 2005

Perc

enta

ge

Other household expenditures for health, percentageHousehold expenditures for pharmaceuticals, percentage

Research on unofficial payments in the health sector of Lithuania

Map of Corruption in Lithuania – 2004, “Transparency International” Lithuanian Chapter. The most representative inquiry of Lithuanian citizens and company heads has been performed by the Lithuanian and British public opinion and market research company “Baltijos tyrimai” / The Gallup Organization.

•The survey included 1015 residents and 1047 company heads.

Map of Corruption in Lithuania 2005, December 2005. Contracting authority: Special Investigation Service of the Republic of Lithuania; Contractor: TNS Gallup. Methodology of research: the method of opinion poll – direct interview.

•The survey included 1009 residents and 519 companies.

Research on Oficially Unaccounted Economy in Lithuania, Vilnius 2004. Department of Statistics under the Government of the Republic of Lithuania.

Research on unofficial payments in the health sector of Lithuania, 2002-2005

Map of Corruption in Lithuania 2005, December 2005. Contracting authority: Special Investigation Service of the Republic of Lithuania; Contractor: TNS Gallup

* - Map of Corruption in Lithuania - 2004 m. “Transparency International” Lithuanian Chapter. Representative inquiries of Lithuanian residents and company heads has been carried out by the British – Lithuanian public opinion and market research company “Baltijos tyrimai” / The Gallup Organization.

* - including monetary and material unofficial payments

Out-patient health care facilities, medical stations

Clinics Local hospitals

Hospitals of national

importance

Emergency services

Index of asking for a bribe

2005 0.17 0.24 0.39 0.49 0.14

2004 None 0.22 0.3 0.52 None

2002 None 0.23 0.44 0,55 None

Bribe payers index2005 0.08 0.22 0.37 0.45 0.06

2004 0.21 0.34 0.56

2002 0.22 0.4 0.58

Average bribe (in litas)2005 86.4 62.3 168 254 37.1

2004* None Average min. – 29

Average min. – 53

Average min. – 96

None

Average max. - 82

Average max. - 195

Average max. - 420

Unofficial payments in the health sector of Lithuania, mil. LTL, 2003-2005

Note. When performing calculations according to the researches made by “Transparency International” and Gallup, it was presumed that people visiting out-patient health care facilities pay bribes only for “consultation”, i.e. every third visit and one more presumption was made that only 50 percent of population visit out-patient health care facilities. According to the research made by the Health Economy Centre in 2001, about 30 percent of residents stated that they had not visited out-patient care facility during the past 2 years.

* - Research on Officially Unaccounted Economy in Lithuania, Vilnius 2004. Department of Statistics under the Government of the Republic of Lithuania.

** - Calculations made by HEC.

In 2005 the amount of “unofficial payments” per capita was 31.7 litas.

2003 2004** 2005**

Research on Officially Unaccounted Economy in Lithuania * (excluding expenditures for gifts and unconventional medicine)

58.0 59.5 59.1

Research on Officially Unaccounted Economy in Lithuania * (including expenditures for gifts and unconventional medicine)

115.0 117.9 117.2

According to the researches performed by Transparency International and Gallup in 2004-2005

88.8 99.6

AVERAGE (of total expenditures) 115.0 103.4 108.4

Non-life insurance. The concept of health insurance

RESOLUTION OF THE INSURANCE SUPERVISORY COMMISSION OF THE REPUBLIC OF LITHUANIA “ON THE APPROVAL OF THE DESCRIPTION OF LIFE INSURANCE AND NON-LIFE INSURANCE GROUPS”. 23 March 2004, No. N-33 Health insurance – insurance of property interests related to health of a natural person, when in association with the insured event related to health of a person, an insurance benefit is paid in the amount equal to the insured amount or its part or to the amount of losses incurred in association with the insured event. Health insurance includes accident insurance and sickness insurance.

Accident insurance group includes such types of insurance, when an insurance company undertakes to pay the insurance benefit in the event of death, damage to health or disability (permanent, temporary or partial) of the insured person in relation with an accident. Accident insurance group includes accidents (including industrial injuries and occupational diseases), when:

amount insurance contracts are concluded;loss insurance contracts are concluded;mixed insurance contracts are concluded;insurance benefit in relation with the injury of passengers is paid.

Sickness insurance group includes such types of insurance, when an insurance company undertakes to pay the insurance benefit in the event of sickness of the insured person. Sickness insurance group includes:

amount insurance contracts;loss insurance contracts;mixed insurance contracts.

Non-life insurance. Health insurance in Lithuania, mil. litas, 1998-2004

Insurance Supervisory Commission under the Ministry of Finance, Insurance in Lithuania, 2002-2004 reviews

23,4

14,3

18,1 18,3 18,817,0 17,1 16,2

18,120,6

23,4

26,0

19,5

14,9

0,0

5,0

10,0

15,0

20,0

25,0

30,0

1998 1999 2000 2001 2002 2003 2004

Sickness insurance (contributions)Accident insurance (contributions)

Sickness insurance (benefits)Accident insurance (benefits)

Non-life insurance. Health insurance in Lithuania, mil. litas, 1998-2004

Insurance Supervisory Commission under the Ministry of Finance, Insurance in Lithuania, 2002-2004 reviews

NON-LIFE INSURANCE* (health insurance)1998 1999 2000 2001 2002 2003 2004

Sickness insurance (contributions) 23.4 14.3 14.9 18.1 19.5 18.3 18.8

Sickness insurance (benefits) 3.5 2.4 2.9 3.4 4.4 4.9 5.2

Benefit/contribution ratio 15.0% 16.8% 19.5% 18.8% 22.6% 26.8% 27.7%

Accident insurance (contributions) 17.0 17.1 16.2 18.1 20.6 23.4 26.0

Accident insurance (benefits) 4.0 3.9 3.8 5.7 7.0 8.6 9.2

Benefit/contribution ratio 23.5% 22.8% 23.5% 31.5% 34.0% 36.8% 35.4%Total (contributions) 40.4 31.4 31.1 36.2 40.1 41.7 44.8Total (benefits) 7.5 6.3 6.7 9.1 11.4 13.5 14.4

Total (benefit/contribution ratio) 18.6% 20.1% 21.5% 25.1% 28.4% 32.4% 32.1%

Supplementary health insurance. Insurance market dynamics Lithuania, according to contributions, in thousand LTL

SEB Vilniaus Bankas

10311172 1183

2511

2898

1372

16931982

13881645

0

500

1000

1500

2000

2500

3000

3500

2001 2002 2003 2004 2005

Thou

sand

lita

s

SEB VB LI Contributions to all other insurance companies

Supplementary health insurance. Average contributions and benefits per one insured in Lithuania,

trends of changes

SEB Vilniaus Bankas

0

200

400

600

800

1000

1200

1400

2001 2002 2003 2004 2005

Average contribution per one insured Average benefit per one insured

Expenditures of employers (companies) for health care in Lithuania

According to expert assessment:

Payments of companies for examinations of their employees’ health and other services make about 40-50 percent of expenditures for health care.

About 50 percent of sickness and accident insurance expenditures are paid by companies.

According to expert opinion, total expenditures of employers (companies) for health care could have made 74 mil. litas in 2005.

Medicament usage by the population of Lithuania and its financing

EU countries: market of pharmaceuticals, mil. USD, 2003

57294094 3544 3234 2726 1918 1873 1490 1394 1326 745 341 195

14040

27193

3850437010

0

5000

10000

15000

20000

25000

30000

35000

40000

Ger

man

y

Fran

ce

Italy

Spai

n

Net

herla

nds

Pola

nd

Swed

en

Aus

tria

Gre

ece

Finl

and

Den

mar

k

Cze

ch R

epub

lic

Hun

gary

Irela

nd

Slov

ak R

epub

lic

Lith

uani

a

Luxe

mbo

urg

Mill

ion

US

dolla

rs

OECD Health Data, 2005; IMS Health

Sales of pharmaceuticals in Lithuania compared to the average of the Western European countries, 2000 (%)

2000, OECD Health Data; 2000, IMS Data

NB. Western European average is calculated only for countries available in OECD data base.

4,8%

7,7%

7,8%

15,3%

17,6%

19,5%

19,9%

21,7%

24,1%

26,0%

30,2%

33,2%

0,0% 10,0% 20,0% 30,0% 40,0% 50,0% 60,0%

Antineoplastics and immunomodulators

Drugs for blood & blood forming organs

Systemic hormone preparates

Drugs for genitiurinary system, sex hormones

Antiinfectivesfor systemic use

Drugs for cardiovascular system

Total

Drugs for nervous system (incl. Psychiatry)

Drugs for musculo-sceletal system

Drugs for alimentary tract metabolism

Dermatologicals

Drugs for respiratory system

NB. Western European average is calculated only for countries available in OECD data base.

4,8%

7,7%

7,8%

15,3%

17,6%

19,5%

19,9%

21,7%

24,1%

26,0%

30,2%

33,2%

0,0% 10,0% 20,0% 30,0% 40,0% 50,0% 60,0%

Antineoplastics and immunomodulators

Drugs for blood & blood forming organs

Systemic hormone preparates

Drugs for genitiurinary system, sex hormones

Antiinfectivesfor systemic use

Drugs for cardiovascular system

Total

Drugs for nervous system (incl. Psychiatry)

Drugs for musculo-sceletal system

Drugs for alimentary tract metabolism

Dermatologicals

Drugs for respiratory system

EU countries: public and private expenditures for pharmaceuticals per capita, in USD, 2003


416

232

349 360280 275

197 203 171247

184112 115

43 36

203

240

117 73

119 121

170 151 17789

64

34 2464 63

0

100

200

300

400

500

600

700Fr

ance

Italy

Ger

man

y

Luxe

mbo

urg

Aus

tria

Swed

en

Finl

and

Net

herla

nds

Den

mar

k

Spai

n

Gre

ece

Cze

chR

epub

lic

Slov

akR

epub

lic

Pola

nd

Lith

uani

a

Public Private

EU countries: public expenditures for reimbursed pharmaceuticals, as percentage of total expenditures for pharmaceuticals, 2003


86,2 83,1 82,776,8 74,8 74,1 73,5 70,2 69,5 67,2

62,557,4 53,7

49,2 49,140,5

33,8

0

10

20

30

40

50

60

70

80

90

100

Irela

nd

Luxe

mbo

urg

Slov

ak R

epub

lic

Czec

h Re

publ

ic

Ger

man

y

Gre

ece

Spai

n

Aust

ria

Swed

en

Fran

ce

Hung

ary*

Neth

erla

nds

Finl

and

Denm

ark

Italy

Pola

nd

Lith

uani

a

EU countries: public expenditures for reimbursed pharmaceuticals per capita in USD, 1995-2003


23 31 29 36

277 276256

271

101111 115

127137 134

165

208

286

119131 129

102112 109

122138

184

79 8474 82

61

112

57 6181

115

29 3422 22 23 27 33 36 43

284 290

327

416

273

886968

58

0

50

100

150

200

250

300

350

400

450

1995

1996

1997

1998

1999

2000

2001

2002

2003

LithuaniaFranceIrelandGreeceCzech RepublicSlovak RepublicPoland

Structure of expenditures for out-patient treatment pharmaceuticals in Lithuania, 2005

Expenditures for reimbursed pharmaceuticals when paying the full price were 188 mil.litas in 2005.


32%

8%14%

46%

Reimbursement of pharmaceuticals by CHIFPopulation surcharges for reimbursed pharmaceuticalsPopulation expenditures for reimbursed pharmaceuticals when paying the full pricePopulation expenditures for non-reimbursed pharmaceuticals

The structure and change of retail trade in pharmaceuticals in Lithuania, 2001-2005


In 2005 residents spent 117 mil. litas for surcharges for reimbursed pharmaceuticals. Expenditures for reimbursed pharmaceuticals when paying the full price were 187.9 mil. litas.

Total expenditures of residents for reimbursed pharmaceuticals in 2005 were 304.9 mil. litas or about 22 percent of total volume of pharmaceuticals sold via the retail network.

Mil. litas 2001 2002 2003 2004 2005Sale via pharmacies 1014.3 960.5 1041.3 1187.8 1387.9Sale via pharmacies, percent of GDP 2.1% 1.8% 1.8% 1.9% 2.0%

Reimbursed pharmaceuticals (retail prices)

557.5 510.7 580.4 662.2 753.3

Non-reimbursed pharmaceuticals (retail prices)

456.8 449.8 460.9 525.6 634.6

SPF expenditures for reimbursement of pharmaceuticals, (presented for payment, excluding centralized purchases)*

360.9 337.8 351.7 385.2 448.4

Expenditures of population for pharmaceuticals

653.4 622.7 689.6 802.7 939.4

Expenditures of population for pharmaceuticals, in percent

64.4% 64.8% 66.2% 67.6% 67.7%

The changes of retail trade in pharmaceuticals in Lithuania, 2002-2005 (mil. LTL)

IMS Health; SPF data

337,8 351,7 385,2 448,4

622,7689,6

802,7

939,4

0

200

400

600

800

1.000

1.200

1.400

2002 2003 2004 2005

Mill

ion

litas

Consumer expenditures for pharmaceuticals, mil. LTL

SPF expenditures for the reimbursement of pharmaceuticals

510,7 580,4 662,2 753,3

449,8460,9

525,6

634,6

0100200300400500600700800900

1.0001.1001.2001.3001.400

2002 2003 2004 2005

Mill

ion

litas

Sales of non-reimbursed pharmaceuticals via theretail network, mil. LTL

Sales of reimbursed pharmaceuticals via theretail network, mil. LTL

SPF data

Change of prescription numbers and average price of pharmaceutical prescriptions for out-patient treatment and

reimbursed from CHIF budget, 1998-2005

0

5

10

15

20

25

30

35

40

45

50

1998 1999 2000 2001 2002 2003 2004 2005

Number of

prescriptions, mil.

Average price ofone prescription,

in LTL

Change of average price for one package of reimbursed pharmaceuticals*, 2001-2004

The change of average price for one package of reimbursed pharmaceuticals*

35,0

40,0

45,0

50,0

55,0

2001 2002 2003 2004

Years

Pric

e

The start of price control

Prices reduced to the EU average

II-nd reduction of prices

* - Methodology: 50 most often used pharmaceuticals have been taken, according to the expenditures, and most often prescribed reimbursed medicine have been selected from them , according to the expenditures which repeat during the four years (22 pharmaceuticals)

IMS Health, 2004

Comparison of expenditures for pharmaceuticals in Lithuania with the EU countries, 2003

2005, OECD Health Data; Health Economy Centre

360286

171

280

203

349

115

416

232

4336

30

40

50

60

70

80

90

100

0,4 0,9 1,4 1,9 2,4

Total expenditures for pharmaceuticals, as percentage of GDP

Publ

ic e

xpen

ditu

res

for p

harm

acut

ical

s as

perc

enta

ge o

f tot

al e

xpen

ditu

res

for

drug

s

Lithuania

PolandDenmark

NetherlandsAustria

Germany

Luxembourg

Ireland

Italy

France

Slovak RepublicCzech Republic

112

Hungary*

86

The size of the circle shows public expenditures for pharmaceuticals per capita, in USD

* - Hungary has presented the data of 2002

CONCLUSIONS (1)

Total expenditures (public and private) in Lithuania for health care activities in percentage of GDP and compared to other EU countries are one of the lowest. In 2003, total expenditures for health care activities per capita made only 312 USD and were one of the lowest in the EU; e.g., in Luxembourg they were 4031 USD, in Poland - 339 USD .

Public expenditures for health care activities per capita in Lithuania amounted to 211 USD in 2003 and were more than 17.5 times lower than respective expenditures in Luxembourg and about 3 times lower than in Czech Republic.

The growth of public expenditures on health care in Lithuania lags behind the pace of GDP growth. The percentage of GDP of public expenditures on health care in Lithuania was constantly decreasing from 4.42 percent in 2000 to 3.91 percent in 2004. It began to grow more rapidly starting with 2005, when the policy of increasing salaries for health care system employees was implemented.

Expenditures on personal health care financed by the means of the Compulsory Health Insurance Fund (CHIF) in Lithuania amount to only 11 percent of the respective average public spending in the Western European countries.

Relative stability of GDP percentage of public and private spending on health care is maintained only through the growth of private expenditures.

CONCLUSIONS (2)

The amount of contribution from the national budget for persons covered by the State is limited by the provision of Article 16 of the Law on Health Insurance – “the amount of contribution per one insured person covered by the means of the State budget is 35 percent of insured income as approved according to the order established in the Law on State Social Insurance Pensions” in 2003. I.e., this amount may not exceed 315.35 litas, however, in 2006 this amount was 304 litas.

From 1 July 2006, the implementation of individual income tax reduction policy was started, and the contributions to the CHIF will respectively decrease. Therefore, the growth of the public financing of the health sector will slow down considerably.

Due to the aforementioned reasons, the growth of the CHIF budget will slow down in short-term and GDP percentage of public financing for health sector will decrease. This will cause even a larger gap between the health care system of Lithuania and the EU level.

CONCLUSIONS (3)

According to the household study data, private spending on health care increased more than by 89 percent from 1999, and in 2005 it amounted to 1 billion 225 million litas.

In 1999, the health expenditure percentage of total household expenditures made only 3.9 percent, and in 2005 it increased to about 5.2 percent. Spending for pharmaceuticals makes major part. In 2005, it reached 76.7 percent.

In 2005, unofficial payments in health care system amounted to about 100 million litas per year and an unofficial payment average amount was 37 - 254 litas.

Complementary health insurance market is not developed in Lithuania. In 2005, complementary health insurance income made only about 3 million litas.

The market of non-life insurance (illness and accident insurance) in 2004 amounted to about 45 million litas, however, the part of benefits in the same year made only 35 percent of premiums received.

According to expert evaluation, in 2005 total expenditures of employers (companies) for health care could have made 74 million litas.

CONCLUSIONS (4)

Total expenditures for pharmaceuticals per capita in Lithuania in 2003 amounted to about 100 USD and were more than 6 times lower than respective expenditures in France and about 50 percent lower than in Czech Republic. However, compared to EU-15 countries higher percentage of GDP is spent on pharmaceuticals in Lithuania like in other new EU countries because medicine prices in common EU market are analogous.

Total (public and private) spending on pharmaceuticals in Lithuania is increasing each year, however, medicine sales market (in USD) is one of the smallest in the EU and amounts to only 20 percent per capita compared to the EU average.

The role of the State in medicine policy is considerably decreasing. Pharmaceutical treatment is discriminated compared with medical services (in respect of reimbursement expenditures for pharmaceuticals). It is the duty of the State to ensure that high quality health products would not become an exclusive privilege to rich population only.

CONCLUSIONS (5)

The portion of public expenditures in total expenditures for pharmaceuticals continuously decreased during 2000-2005 and in 2005 it made only 32.3 percent.

In 2005, private expenditures for reimbursed pharmaceuticals amounted to about 305 million litas (including extra payments for reimbursed pharmaceuticals and expenditures for full-price reimbursed pharmaceuticals). It makes about 22 percent of total spending for pharmaceuticals sold via retail trade network or 44 percent of total retail price of reimbursed pharmaceuticals.

The distribution of expenditures reimbursed by the CHIF per capita in different municipalities varies: from LTL 75 per capita in Šalčininkai (small town) region to LTL 195 in Palanga (resort town on the coast).

CONCLUSIONS (6)

Volume growth of private expenditures for pharmaceuticals reflects the dynamics of population needs. Recent statistics show that people’s care of health has increased, and even without an adequate help from the State they tend to use more pharmaceuticals. High percentage of household spending for pharmaceuticals influences population health state because due to limited financial resources people are forced to reduce expenditures for other paid services (including examinations and diagnostics, stomatology, paid vaccines and preventive measures, psychotherapy, rehabilitation and sanatorium services).

Growing household expenditures for personal health care and pharmaceuticals force inhabitants to seek in-patient treatment even in cases, even when such treatment is unnecessary. Sociological researches show that part of population seeks to be treated in hospitals in order to save money for food and pharmaceuticals.

ANALYSIS AND PROPOSALS ON THE TRENDS OF HEALTH CARE SERVICES IN LITHUANIA

Factors causing the deepening of disproportion among the CHIF income, demand of health promotion services and obligations

undertaken by the State According to the Ministry of Finance forecast GDP will grow until 2009.

According to the Ministry of Finance forecast salaries will change until 2009.

Income tax tariff for individuals is decreasing: from 1 July 2006 it is reduced to 27 percent, and from 1 January 2008 - to 24 percent (version 1).

Income tax tariff of individuals is decreasing: from 1 July 2006 it is reduced to 27 percent, and from 1 January 2008 - to 20 percent (version 2).

The contribution from the State budget for covered persons becomes 315.35 litas and from 2007 is not growing any more.

According to the trilateral agreement of 3 May 2005, the salary of physicians and nurses will grow by 20 percent annually during the period of 2007-2008.

The fourteenth Government has obliged itself to include the actual estimates of the depreciation of medical appliances and buildings into the tariffs for health care services.

Growing demand for high-quality health care services and pharmaceuticals.

Growing costs for energy and utilities.

Income tax portion change transferred to the CHIF budget due to income tax tariff reduction, mil. LTL, 2006-2010

HEC has performed the calculations based on the data of the Ministry of Finance of the RoL, SPF and the Department of Statistics under the Government of the Republic of Lithuania

1620

1930

2102

2287

2488

1485

1769

1926

2096

2280

1485

17691712

1863

2027

1427

1552

1689

1200

1600

2000

2400

2006 2007 2008 2009 2010

Mill

ion

litas

The amount of income tax transferred to CHIF, mil. LTL(if the income taxis not reduced)

The amount of income taxtransferred to CHIF, mil. LTL(after the reduction ofrate of the income taxto 27 percent)



The CHIF budget income changes due to income tax reduction for individuals, mil. LTL, 2006-2010


3.001

3.402

3.654

3.927

4.225

2.865

3.478

3.736

4.017

2.865

3.264

3.503

3.763

3.241

2.979

3.192

3.426

2.500

3.000

3.500

4.000

4.500

2006 2007 2008 2009 2010

Mill

ion

litas

Income of CHIF budgetin mil. LTLif the income taxis not reduced)

Income of CHIF budgetin mil. LTL(after the reductionof the income taxrate to 27 percent)Income of CHIF budgetin mil. LTL(after the reductionof the income taxrate to 24 percent)Income of CHIF budgetin mil. LTL(after the reductionof the income taxrate to 20 percent)

The CHIF budget income, as percentage of GDP in relation to income tax reduction for individuals, 2006-2010


3,87%

4,02%3,95%

3,87%3,80%

3,69%

3,83%3,76%

3,68%3,61%

3,69%

3,83%

3,52%3,45%

3,38%

3,22%3,15%

3,08%3,0%

3,4%

3,8%

4,2%

2006 2007 2008 2009 2010

Perc

enta

ge

Income of CHIF budgetas percentage of GDPif the income taxis not reduced)

Income of CHIF budgetas percentage of GDP(after the reductionof the income taxrate to 27 percent)Income of CHIF budgetas percentage of GDP(after the reductionof the income taxrate to 24 percent)

Income of CHIF budgetas percentage of GDP(after the reductionof the income tax

rate to 20 percent)

The CHIF budget income, in mil. LTL, after respective income tax reduction for individuals and contribution fixation for the insured by the

State (315.35 LTL). Summary table, 2006-2010


Summary table, CHIF income 2006 2007 2008 2009 2010

The income of CHIF budget, mil. LTL (after reduction of the tariff of the income tax of individuals to 27%) 2.865 3.241 3.478 3.736 4.017



The losses of CHIF budget, mil. LTL (after reduction of the tariff of the income tax of individuals to 27%) 135 161 176 191 208



The sum of the losses of CHIF budget, mil. LTL (after reduction of the tariff of the income tax of individuals to 27%)

872

The sum of the losses of CHIF budget, mil. LTL (after reduction of the tariff of the income tax of individuals to 24%)

1.572

The sum of the losses of CHIF budget, mil. LTL (after reduction of the tariff of the income tax of individuals to 20%) 2.506

The need of extra resources in 2007 to fulfill the State obligations in the health sector

According to the trilateral agreement of 3 May 2005, the salary of physicians and nurses will grow by 20 percent annually during the period of 2007 - 2008. The need of resources for 2007: 650 million litas is needed for the raise of salary for medical personnel and further fulfillment of the trilateral agreement.

The fourteenth Government has obliged itself to include the actual estimates of the depreciation of medical appliances and buildings into the tariffs for health care services. The need of resources for 2007: at least 100 mil. litas is needed for raise of tariffs for health care services including the estimates of the depreciation of medical appliances and buildings into them.

Growing demand for high-quality health care services and pharmaceuticals and increasing costs for energy and utilities. The need of resources for 2007: not less than 250 mil. litas.

RECOMMENDATIONS

Targets to ensure consistent development of the health care system of Lithuania until 2010

Ensure that total health care expenditures (public and private) in Lithuania make not

less than 6.5 – 6.8 percent of GDP by 2010 (this is the average amount of the new EU countries in 2004).

Ensure that the percentage of public expenditures for health makes not less than 5.5 percent of GDP by 2010 and approximates the average amount of the new EU countries in 2003-2004.

Ensure that the portion of public expenditures in total spending for health makes not less than 75 percent (close to the average percentage of the new EU countries).

While ensuring the consistent development of health promotion services financed from the CHIF budget, maintain the current proportions of the CHIF expenditures, according to the type of expenditures, until 2010.

Ensure that the considerable portion of public expenditures in health sector is designated to improve quality and accessibility of services as well as infrastructure of medical institutions.

While encouraging the financing of health sector from private resources, create legal and economic conditions for supplementary health insurance development.

* - WHO, European health for all database, 2006

** - The impact of ageing on public expenditure: projections for the EU25 Member States on pensions, health care, long term care, education and unemployment transfers (2004-2050). Report prepared by the Economic Policy Committee and the European Commission (DG ECFIN) Brussels, 6 February 2006, ECFIN/EPC(2006)REP/238

Measures for implementation of targets 1

Take a political decision by the common agreement of all parliamentary parties concerning the GDP growth percentage of public expenditures for health care. If such a decision is made, the average GDP (5.5 percent) of public expenditures for health care in new EU countries as forecasted in the report on population ageing prepared by the European Commission, in Lithuania would be reached by 2010.

It is necessary to as soon as possible amend Article 16 of the Health Insurance Law, which regulates the State contribution amount for one insured individual that the contribution amount should not be tied in percentage to individual’s income as approved by the State Social Insurance Pensions Law in 2003.

Set the State contribution amount for one insured individual in relation to gross average wage of the past year.

Measures for implementation of targets 2

Ensure monitoring of consistent development of the health system in Lithuania.

In 2007, create legal and economic preconditions to uniform the conditions of the activities of public and private providers of health care services (inclusion of depreciation estimates into the service tariffs, financing via the State Investment Programme only national projects without separation of public and private sector).

In 2007, create legal and economic preconditions for the development of supplementary health care system based on tax exemptions. Supplementary health insurance is one of the ways proved in the international practice as the means to enhance the growth of health system and to ensure more equal distribution of risks associated with diseases among population. Fast and considerable growth of public financing should be combined with the creation of mechanism for more efficient attraction of private resources to the health sector.

In 2007, create legal and economic preconditions for the implementation of current accounts from which health promotion services, medical commodities and pharmaceuticals non-reimbursable by the State could be paid.

The consistent development priorities of the health care system in Lithuania

Since the CHIF revenue growth in 2005-2006 was primarily designated to increase salaries for medical personnel, therefore, these expenditures together with the social insurance contributions exceed 75 percent in the structure of Individual health care facility. However, the quality of services has not substantially improved. It is necessary to use the planned growth of the financing of the health system not only for the rise of salaries but also for improvement of service accessibility and infrastructure of medical institutions.

Priorities Reduction of morbidity from heart and circulatory system, oncology, infectious diseases, reduction of population traumatism and its consequences. Ensuring the effective prevention of diseases (special attention should be devoted to the health care of pregnant women and infants as well as to the preservation and improvement of the health of children and young people). Improvement of the mental health of the society and the implementation of active measures for the prevention of drug and alcohol addiction. Development of primary care and primary diagnostics. Reorganization of emergency services provision. Development of outpatient care services and specialised diagnostics. Restructuring of the provision of in-patient services (reduction of the number of unnecessary hospitalizations and rising investments designated for the modernisation of hospitals), the development of day hospital services. Optimisation of in-patient rehabilitation services and the development of outpatient rehabilitation services. Ensuring that the Lithuanian market contains only high-quality, safe, efficient and affordable pharmaceuticals.

Possible development scenarios of health care system financing

Possible development scenarios of health care system financing until 2010

Loss coverage scenario. The State contribution for the insured is increased in order only to cover the CHIF losses related to the reduced income tax of individuals. The percentage of GDP of public expenditures would amount to only 4.2 percent by 2010.

Minimum-financing scenario. The State contribution for the insured is gradually increased in order that the public financing of the health system amounts to 5 percent of GDP by 2010. During 2007-2008 the increase of the State contribution by 50-55 percent is envisaged, from 2006 – the growth by 23 percent and 2010 – by 15 percent.

Optimal-financing scenario. The State contribution for the insured is increased to the extent in order that the public financing of the health system amounts to 5.5 percent of GDP by 2010. In 2007 the sharp increase (by 100 percent) of the State contribution for the insured is envisaged (striving to ensure the fulfilment of obligations on salary increase undertaken according to the trilateral agreement), in 2008 – increase by 60 percent, in 2009 – by 20 percent, and in 2010 – increase by 10 percent . In 2010 the average of the new EU countries of 2003 – 2004 will be reached.

* - WHO, European health for all database, 2006

* - The impact of ageing on public expenditure: projections for the EU25 Member States on pensions, health care, long term care, education and unemployment transfers (2004-2050). Report prepared by the Economic Policy Committee and the European Commission (DG ECFIN) Brussels, 6 February 2006, ECFIN/EPC(2006)REP/238

Loss coverage scenario. Summary table


LOSS COVERAGE SCENARIO

The amount of the income tax transferred to the CHIF (the amount growing to the same extent as salaries)

2006 2007 2008 2009 2010

Total public expenditures for health care, mil. litas 3.161 3.725 4.007 4.314 4.649

Total public expenditures for health care , percentage of GDP 4.1% 4.4% 4.3% 4.3% 4.2%

CHIF budget, mil. litas 2.865 3.402 3.654 3.927 4.225

The amount of contributions from the State budget for persons covered by the State, mil. litas

611 794 1.023 1.057 1.094

The amount of income tax transferred to CHIF, mil. litas 1.485 1.769 1.712 1.863 2.027

Compulsory health insurance contributions from companies, institutions and organizations as well as from self-employed natural persons, mil. litas

529 572 623 678 737

Other income of CHIF, mil. litas 241 267 296 329 367

CHIF budget, percentage of GDP 3.7% 4.0% 3.9% 3.9% 3.8%

Contribution from the State budget for one insured, in litas

304 372 481 499 520

Contribution of one employed person in litas 1.600 1.873 1.882 2.061 2.258

Contribution from the State budget for one insured, percentage of the contribution of employed person

19.0% 19.8% 25.6% 24.2% 23.0%

Loss coverage scenario. Summing-up

In the event the CHIF financing is increased according to the scheme of the “Loss coverage scenario” during 2007-2010, none of the obligations undertaken by the State in 2005-2006 will be met.

Decreasing public financing (as percentage of GDP) will condition further retardation of the health system of Lithuania compared to other EU countries.

Degradation of the health system will determine the worsening of population health indicators, as well as worsening of quality and accessibility of services provided and emigration of medical personnel abroad.

Minimum-financing scenario. Summary table


THE MINIMUMUM SCENARIO OF THE GROWTH OF PUBLIC EXPENDITURES FOR HEALTH CARE

The amount of the income tax transferred to the CHIF (the amount growing to the same extent as salaries), in 2010 total public expenditures for health care make 5 percent of GDP

2006 2007 2008 2009 2010


Total public expenditures for health care , percentage of GDP 4.1% 4.5% 4.8% 4.9% 5.0%

CHIF budget, mil. litas 2.865 3.524 4.052 4.617 5.140

The amount of contributions from the State budget for persons covered by the State, mil. litas

611 917 1.421 1.747 2.009



529 572 623 678 737




304 429 668 825 954

Contribution of one employed person in litas 1600 1873 1882 2061 2258


19.0% 22.9% 35.5% 40.0% 42.2%

Minimum-financing scenario. Summing-up

In the event the CHIF financing is increased according to the scheme of the “Minimum-financing scenario” during 2007-2010, none of the obligations and targets undertaken by the State in 2005-2006 will be fully met.

Slowly growing public financing (as percentage of GDP) will actually freeze current situation and retardation of health system of Lithuania compared to other EU countries, and will not create preconditions for the substantial reformation and consistent development of the system.

Optimal-financing scenario. Summary table


THE OPTIMAL SCENARIO OF THE GROWTH OF PUBLIC EXPENDITURES FOR HEALTH CARE The amount of the income tax transferred to the CHIF (the amount growing to the same extent as salaries), in 2010

total public expenditures for health care make 5.5 percent of GDP

2006 2007 2008 2009 2010


Total public expenditures for health care , percentage of GDP

4.1% 4.9% 5.3% 5.5% 5.5%

CHIF budget, mil. litas 2.865 3.830 4.586 5.216 5.711The amount of contributions from the State budget for persons covered by the State, mil. litas

611 1.222 1.955 2.346 2.581



529 572 623 678 737




304 572 919 1108 1225

Contribution of one employed person in litas 1600 1873 1882 2061 2258


19.0% 30.5% 48.8% 53.8% 54.3%

Optimal-financing scenario. Summing-up

In the event the CHIF financing is increased according to the scheme of the “Optimal-financing scenario” during 2007-2010, obligations and targets undertaken by the State in 2005-2006 will be met.

Growing public financing (as percentage of GDP) will allow to gradually reduce the retardation of health system of Lithuania compared to other EU countries and will create preconditions for the substantial reformation and consistent development of system.


Comparison of scenarios. The CHIF budget growth, mil. LTL

CHIF budget

3.830

4.586

5.216

5.711

2.6112.865

3.524

4.052

4.617

5.140

3.4023.654

3.927

4.225

2.000

2.500

3.000

3.500

4.000

4.500

5.000

5.500

6.000

2005 2006 2007 2008 2009 2010

Mill

ion

litas

CHIF budget in mil. LTL (optimal growthscenario -public expenditures5.5 percent of GDP)

CHIF budget in mil.LTL (minimal growthscenario -public expenditures5.0 percent of GDP)

CHIF budget in mil.LTL (losscoveragescenario)

Comparison of scenarios. The growth of contributions from the State budget for persons insured by the State, mil. LTL


The amount of contributions from the State budget for insuredpersons covered by the State

2.346

2.581

611

917

1.023

1.955

1.222

1.747

2.009

1.421

570

1.0941.057

794

400

800

1.200

1.600

2.000

2.400

2.800

2005 2006 2007 2008 2009 2010

Mill

ion

litas

The amount of contributionsfrom the State budgetfor insured persons covered by the State in mil.LTL (optimal growthscenario -public expenditures5.5 percent of GDP)The amount of contributionsfrom the State budgetfor insured personscovered by the State in mil.LTL (minimal growthscenario -public expenditures5.0 percent of GDP)

The amount of contributionsfrom the State budgetfor insured personscovered by the State in mil.

,LTL (loss coveragescenario)

Comparison of scenarios. Public expenditures for health, as percentage of GDP


Public expenditures for health care

5,5%

5,0%

4,3% 4,3% 4,2%3,9% 3,8% 3,8%

5,3%

4,9%

5,5%

4,8%4,5%

4,1%4,1%

4,9%

4,4%

4,1% 4,1%4,2%

3,0%

3,5%

4,0%

4,5%

5,0%

5,5%

6,0%

2005 2006 2007 2008 2009 2010

Perc

enta

ge o

f GD

P

Total public expendituresfor health care, percentage of GDP(optimal growth scenario - public expenditures5.5 percent of GDP)

Total public expendituresfor health care,percentage of GDP(minimal growthscenario - public expenditures5.0 percent of GDP)

Total public expendituresfor health care,percentage of GDP(loss coveragescenario)

Total public expendituresfor health care,percentage of GDP (scenario in that caseif losses are notcovered

Comparison of scenarios. Comparison of the growth of contributions from the State budget per one person insured by the

State, mil. LTL


Contribution from the State budget per one insured person

1452

1600

1873 1882

2061

2258

11081225

825954

481 499 520919

572304264

668

429372

200

600

1000

1400

1800

2200

2005 2006 2007 2008 2009 2010

Mill

ion

litas

Contribution of an employedperson per one insured, in LTL

Contribution from the Statebudget per one insured, in litas (optimal growthscenario – public expenditures5.5 percent of GDP)

Contribution from the Statebudget per one insured,in litas (minimal growthscenario – public expenditures5.0 percent of GDP)

Contribution from the Statebudget per one insured,in litas (loss coveragescenario)

Comparison of scenarios. Contribution from the State budget per one person insured by the State as percentage of the

contribution of an employed person


Contribution from the State budget per one person insured by the Stateas percentage of the contribution of an employed person

53,8% 54,3%

40,0%42,2%

19,8%

25,6% 24,2% 23,0%

48,8%

30,5%

35,5%

22,9%

19,0%18,2%

10,0%

15,0%

20,0%

25,0%

30,0%

35,0%

40,0%

45,0%

50,0%

55,0%

60,0%

2005 2006 2007 2008 2009 2010

Perc

enta

ge

Contribution from the Statebudget per one insured,as percentage of thecontribution of an employedperson (optimal growthscenario – public expenditures5.5 percent of GDP)

Contribution from the Statebudget per one insured,as percentage of thecontribution of an employedperson (minimal growth scenario – public expenditures5.0 percent of GDP)

Contribution from the Statebudget per one insured,as percentage of thecontribution of an employedperson (loss coveragescenario)

Comparison of scenarios. The growth of CHIF expenditures for pharmaceuticals, mil. LTL


CHIF expenditures for pharmaceuticals1142

1028

731785

845766

917

1043

484507

705

810

923

680

400

500

600

700

800

900

1000

1100

1200

2005 2006. 2007 2008 2009 2010

Mill

ion

litas

CHIF expendituresfor pharmaceuticals,in mil. LTL (optimalgrowth scenario - public expenditures5.5 percent of GDP)

CHIF expendituresfor pharmaceuticals,in mil. LTL (minimalgrowth scenario - public expenditures5.0 percent of GDP)

CHIF expendituresfor pharmaceuticals,in mil. LTL (losscoverage scenario

Comparison of scenarios. Comparison of three financing scenarios (the forecast of health care expenditures in Lithuania for the year

2010) with the data of the EU countries of 2003


940

1926

794

22632506

318

211

248

1758

1595

495

2932

2684

3700 602

40

50

60

70

80

90

100

5 6 7 8 9 10 11 12

The percentage of total expenditures for health care of GDP

The

perc

enta

ge o

f pub

lic e

xpen

ditu

res

in

tota

l exp

endi

ture

s fo

r hea

lth c

are

Lithuania

Luxembourg

Denmark

Germany

Sweden

Netherlands

France

Austria

Greece

HungaryPortugal

FinlandSlovak Republic

Czech Republic

Poland

The size of the circle shows public expenditures for health promotion per capita

in US dollars

604

411456

542Lithuania-2010 (N)

Lithuania-2010 (O)

Lithuania-2010 (M)Lithuania-

2010 (K)

study financing of health care system of lithuania and accessibility of health care services to...

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