LITHUANIA | Medical | Health System
1. Key features of the healthcare system
The Lithuanian National Health System (LNHS) provides both personal and public health services. It operates at both state and municipal levels and comprises three “grades” of health care provision. Institutions providing health care may be private or public.
Primary health care services (grade 1) are available to all Lithuanian residents and are focused on patients' basic health issues. Patients first consult their family physician who decides what kind of help is needed and if it is necessary to consult a specialist. Family practitioner services are funded by the National Health Insurance Fund. Current legislation states that everyone is free to choose the family physician and health care institution which is either closest to his/her place of residence or most convenient. In recent years, the number of private primary health care institutions has grown rapidly. These institutions usually employ one or more family physician. Private primary health care institutions have contracts with the National Health Insurance Fund which means that there are no charges for family physician services.
Secondary and tertiary health care services (grades 2 and 3), which are classified respectively as ambulatory and stationary, are provided by municipal health care institutions, working under the Ministry of Health. Secondary and tertiary health care services are provided via a compulsory health insurance scheme. Secondary and tertiary health care institutions such as university hospitals, offer highly specialized and skilled health care services including those requiring the use of complex diagnostic technology and treatment methods. The patient also has the right to choose the secondary or tertiary care institution and physician.
In Lithuania, emergency medical assistance is provided free of charge to anyone working in the country (the cost of health care is covered by taxes) and to citizens of the European Union in possession of a valid European Health Insurance Card (EHIC) or having a provisional certificate of insurance replacing the EHIC. Citizens from countries outside the EU should have private health insurance. Without either the EHIC or private insurance, patients will be charged for any medical treatment they receive. Anyone from outside Lithuania is advised to go directly to a hospital (Grade 3 institution) in case of medical emergency.
2. Particular features of the system relating to emergency medical care
The system for providing emergency medical assistance in Lithuania has no particular exceptional features. The emergency phone number for medical assistance is 112. It should be noted that doctors and medical staff do not always speak good English, especially those belonging to the older generation. Documents are also written in Lithuanian.
Nationals from other countries should note that only Grade 3 hospitals provide a full package of emergency medical services. If there are no Grade 3 hospitals in a particular town, other health care institutions will provide assistance.
3. Significant constraints on the availability of emergency medical care
The average waiting time for an ambulance (from call to arrival) is 16 min. Although complaints about the emergency medical services have recently decreased, a number of problems still remain in relation to the provision and financing of ambulance services. The emergency medical services are severely stretched due to an ever increasing number of calls, the relative inaccessibility of health care services, especially in primary care health institutions and the fact that there is a shortage of specialists able to work with ambulance crews. Only about 35 percent of all patients delivered by ambulance to hospitals are actually admitted.
Research shows that the number of family physicians in Lithuania is sufficient but they are unevenly distributed, leaving some municipalities without. In Vilnius, patients wait about 7 days for an appointment with a doctor. In private institutions the wait can be reduced to 3 days and in public institutions the wait can be as long as 12 days.
4. Different roles and responsibilities of staff working in emergency medical care
Where emergency help is needed, paramedics will arrive once the ambulance has been called. A junior doctor may treat the patient under the doctor’s supervision. The patient may also be examined by a group of medical students. Although the patient’s treatment will be administered by the doctor, nurses will carry out any examinations eg. taking blood or urine samples, in accordance with the doctor’s instructions. They will also conduct cardiograms, dress wounds, fill out documents and perform other tasks required by the patient’s condition.
5. Cultural or religious issues
Patients must inform medical staff of any relevant religious or cultural beliefs. They must be fully informed about any examinations and treatments which are necessary and must give written agreement. If a patient’s belief or religion prohibits a particular type of treatment, this will not be given unless doctors decide, in consultation, that the treatment is necessary in order to save life.
It is usual in Lithuania for women to be examined by male doctors. Children and adolescents only receive treatment after permission has been given by their parents or carers.
6. Form of Address
In Lithuania it is usual for doctors to address their patients formally ie title and surname only.
7. References
https://lncp.lt/healthcareinlithuania/
Štaras, K., Vedlūga, T., & Kalvelytė, N. (2013). Assessment and Analysis of Health Care Institutions Service Accessibility and Acceptability. Health Sciences, 23(4 (89)), 27-33.
Zdanavičienė, Daina, et al. Greitosios medicinos pagalbos darbuotojų darbo organizavimo ypatumų įvertinimas. Diss. Kauno medicinos universitetas, 2013.