Executive summary

Latvia is facing a dual challenge of a considerable public health burden and limited resources to address it. Latvia has high rates of smoking, harmful alcohol consumption and obesity, leading to a high burden of non-communicable diseases. These factors contribute to Latvia having the lowest life expectancy in the OECD, at 74.9 years versus the OECD average of 80.7 years. At the same time, resources for the health system are limited. Latvia has one of the lowest levels of health spending in the OECD, both in terms of per capita expenditure (USD PPP 1 924 compared to an OECD average of USD PPP 4 170) and as a percentage of GDP (6.2% in Latvia versus 8.9% in the OECD).

In this context, this review identifies scope for Latvia to improve the efficient use of existing resources, to strengthen existing policies and practices, and – if additional investment in health were made available – where the most impactful areas to direct these resources would be. It looks at the public health system as a whole, and provides an in-depth review of three priority topics: obesity, secondary and tertiary prevention, and pharmaceuticals.

Latvia’s Ministry of Health has a clear strategic focus on prevention and health promotion. However, when it comes to delivering public health interventions, general practitioners (GPs) and municipalities are expected to play a key role – and both appear over-stretched and under-resourced. Allowing other health system actors to take on some GP tasks – such as pharmacists offering routine health checks – and giving more incentives to undertake prevention activities could help increase capacity. To further encourage healthy behaviours, Latvia is working on new initiatives such as more comprehensive regulation to tackle harmful alcohol consumption and a planned co-operation with industry on reformulation.

Obesity is a large public health challenge, with over a quarter (26%) of the population obese. Latvia has started to address the issue through a number of policies and interventions, but more can and should be done. First, Latvia should create a comprehensive policy package by expanding or redesigning existing policies to have maximum impact and reach a larger population. For example, the advertising regulations on energy drinks could be expanded to other unhealthy food and drinks, and the food labelling scheme should be redesigned to support consumers in making healthier choices. Second, as many initiatives currently rely on project funding, it is important to ensure their long-term sustainability through effectiveness evaluation and capacity building. Third, doctors and other medical specialists should be enabled to treat obesity through guidelines and changes in reimbursement, to prevent further complications.

In Latvia, there are some clear shortcomings when it comes to secondary and tertiary prevention: cancer screening rates are low, and complications from chronic diseases such as diabetes are common. To strengthen Latvia’s secondary and tertiary prevention there is a clear need for patient and population education, covering topics such as screening, disease management, use of generics and appropriate use of antibiotics. GPs and their practice nurses could take a more active role in this. The uptake of cancer screening could also be improved by using text message invites or pre-booked appointments. For chronic conditions, there is a need to establish clearer patient pathways to improve quality of care for these patients, for example by improving gatekeeping activities to specialist care visits and by aligning the reimbursement schedule accordingly. Ultimately, to make meaningful improvements in both early disease detection and disease management, there is a need to create more capacity in primary care.

While Latvia has the building blocks in place for a robust and well-regulated pharmaceutical sector, spending on pharmaceuticals accounts for 27% of expenditure on health, compared to the OECD average of 16%. At the same time, access to medicines is not improving and Latvians still bear the costs of more than 60% of outpatient pharmaceutical expenditure out of their pockets, well above the average level of 38% in OECD countries. To reduce pharmaceutical spending, Latvia should encourage bioequivalent generics by revising the current distribution margins, ensuring that doctors and pharmacists are incentivised to prioritise the cheapest available alternative product, and educating patients and providers on the efficacy and safety of generics. To make pharmaceuticals more accessible for patients, Latvia should consider including outpatient medicine co-payments in the cap on out-of-pocket expenditure, and increasing the public sector reimbursement rate, starting with pharmaceuticals included in the lowest reimbursement category.