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Monday 30.03.2020 | Name days: Nanija, Ilgmārs, Igmārs

State Audit: accessibility of family doctor services in Latvia remains limited

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healthcare, family doctors, improvement, accessibility, services, LatviaTwo years since Latvian State Audit (VK) had submitted its report on efficiency of outpatient healthcare services not a single one of the previously submitted recommendations have been adopted to make the role of family doctors in healthcare more fitting for patient interests and further improve accessibility of such services, VK has concluded.

Recommendations were provided in order to improve efforts to diagnose illnesses and organize their treatment, provide patients all services within family doctors’ professional competence, as well as reduce the number of times patients are sent to other specialists in situations when family doctors are able to provide assistance instead, VK notes.

Healthcare Ministry needs to continue the work commenced in this area and carefully monitor the influence of adopted changes in order to look for solutions if need be.

The deadline for the adoption of VK’s provided recommendations has been extended to September.

«Healthcare Ministry’s adopted family doctors work quality assessment methodic is still unable to secure the initial goal – provide better patient care. This much is confirmed by results from the National Health Service’s survey of family doctors,» as reported by State Auditor Elita Krūmiņa.

«Although Healthcare Ministry is responsible for this situation as the industry’s leading institution, without involvement from family doctors in important processes and constructive support it is hard to expect any worthwhile improvements. Positive changes are possible only through cooperation of all involved sides,» notes Krūmiņa.

More money, fewer requirements

Since 2018 Healthcare Ministry has increased state budget payments per processed person a month by 63%. The annual performance evaluation fee has been increased 56%. Tariffs for family doctors’ manipulations have also been increased. However, VK believes there are no reasons to think accessibility of healthcare services has improved in any way.

In 2017 healthcare ministry performed changes to the annual performance system, reducing the number of criteria (from 13 to eight), excluding such important indexes like cancer screening monitoring, cardiovascular risk assessment and health state assessment.

Now quality assessment criteria are «more financially valuable», family doctors are rewarded more generously, but at the same time the requirements presented to doctors are also reduced, VK concluded.

While in 2015 annual family doctors’ performance fees reached EUR 700 000 per 13 criteria, in 2018, with the number of criteria reduced to eight, family doctors were paid nearly two million euros or 171% more than before, VK notes.

At the same time, results from 2018 show that the new system have not increased doctors’ motivation, because only 4% of doctors have managed to comply with all eight criteria, whereas 60% of doctors have only met half of those criteria, VK concludes.

Survey results also show that 36% of doctors still find the system as too difficult to understand, 32% of doctors reach out to target groups only when there are fewer other patients and time, whereas 18% perform this task episodically, VK reports.

Newly-adopted activities have yet to yield the desired result

By rejecting multiple performance evaluation criteria, no new measures were adopted or the solutions turned out expensive. With that, no considerable improvements were achieved, VK notes.

For example, the excluded criterion for Mamogaphy and cervical cancer screening has been replaced with a pilot project as part of which family doctors are able to receive additional fee (EUR 500 per quarter), because in practice the responsiveness of registered patients for screening is 50% for cervical cancer screening and 60% for breast cancer screening. However, 46% of 424 family doctors that had participated in the pilot project have not completed any of the indexes outlined in the screening.

Data from the National Health Service on cancer screening also suggests overall responsiveness indexes improve insufficiently.

Latvian government and responsible institutions still have not found efficient instruments to reduce the number of family doctor’ prescribed visits to secondary outpatient care specialists, VK notes. The number of such prescribed cases has a tendency to increase.

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