Assessment and recommendations

In the context of tough epidemiological, financial and organisational challenges, Latvia’s health system is delivering broadly effective and efficient care to the population. Since independence in 1991, the Latvian health system has experienced multiple cycles of far-reaching reorganisation and unanticipated external shocks. An initial shift toward decentralisation (away from the inherited Soviet-style centralised health system) created 119 municipalities. Within the health system, these were meant to manage service delivery and drive reforms at the local level. Many, however, had a population of less than 2 000. Later thinking concluded that a decentralised system was not appropriate for a small country with a population of around 2 million, and Latvia shifted back to more centralised governance. The most recent and most profound external shock, however, was a near-halving of the health budget, following the 2008 global financial crisis. Faced with these challenges, there is nevertheless much to praise in Latvia’s health system, and a range of innovative aspects that OECD health systems could learn from.