Text: Audrius Simaitis

My efforts to change the outlook of the Lithuanian health system started in January 2009 when I created the very first plan for how to bring about the change, long before the Ministry of Health started the current reform for this sector. Mr. Žilvinas Beliauskas was a wonderful partner in this enormous effort at that time but government institutions paid little attention, if any.

When in autumn of 2009 the Ministry of Health started the current reform it was obvious that the suggested changes, although important, will not bring a long term ongoing success as much deeper changes tackling the main underlying issues were required.

I have created a concept that is called "Health Care Reform Based on Values". The main idea of this concept is to create 3 medical regions in Lithuania with university centres as the main coordinating institutions in each of the region. Vilnius and Kaunas already have such an institution and Klaipeda does not.

One of the obvious problems that are the main source of underlying current problems, such as corruption, is the fact that the directors of the hospitals have too much power. Indeed their powers could be compared to the Kings of the middle ages. There is no control and accountability for their actions, as many Boards in the hospitals do not have any decision making powers. To compound the issue, six years ago Parliament issued a law that the there is no retirement age limit for the heads of the hospitals. They are the only category in the country to have such indulgence.

These are just a few examples to illustrate the fact that there is too much power concentration in one hand. This led to the situation where doctors and nurses are very passive and over the years they never learned to express their concerns or opinions publicly purely due to the fear. The fact that doctors accept unofficial payments also contributes significantly to the stagnation in the system.

Therefore we need to create an institution that will tackle these issues and will release the potential currently suppressed by existing structures and fears.

This leads to the next idea described in the "Health Care Reform based on Values". Each of the 3 regions should be governed by the elected/appointed Boards that would consist of the doctors, nurses, directors of the hospitals, representatives of the public and representatives of the patients' organizations. In this way the balance of the power between the directors of the hospitals and doctors will be achieved. The Regional Board will be responsible for the strategic decisions and the hospitals will be responsible for the implementation of these decisions.

And the integral part of this concept is the New Physician's contract that would encompass all the modern aspect of the physicians’ role in today's society. The concept also foresees significant change in the role of nurses as the current role of the nurses in Lithuania is well beyond the times.

Since autumn 2009 I have made multiple presentations of "Health Care Reform based on Values" to hospitals, various organizations, including presentations to the Speaker of the Parliament Mrs. Irena Degutiene, to the Health Care Minister Mr. Algis Caplikas, to the health care team of the President Dalia Grybauskaite. Various national mass media outlets published a lot of my articles reflecting these ideas.

In the continuation of these efforts to bring about the change, I organized a Western Lithuanian group of doctors and patients. This group in collaboration with Klaipeda University organized a Conference on the 15th of January 2010. About one hundred representatives of the doctors, patients' organizations and nurses in Western Lithuania took part in this Conference. The Resolution of this Conference fully supported the idea of establishing Klaipeda’s University Hospital with the idea to create the Association of all three Hospitals in Klaipeda as an initial step. The Resolution also supported the idea of establishing a Board of the Association with the thought to bring about balance between the administrators of the Hospitals. This also would enable the implementation of modern methods of health care management.

Basically there was no reaction from the government institutions to this Conference, and there two main reasons for that. Firstly, Vilnius and Kaunas University Hospitals do not want to loose their dominating status, as this obviously is associated with the finances. They have a lot of power and influence on the Ministry of Health to a degree that some of the prominent figures state that health care in Lithuania is governed by them and not by the Minister. Secondly, is the very important reason that most of the directors of the hospitals in Klaipeda do not want to have the University Centre as their own role could be different after the Klaipeda’s University Hospital is established.

This was very well demonstrated during the latest debate /forum which was initiated by the Mayor of Klaipeda and myself on the 26th November 2010. Only one Director of Klaipeda's three major Hospitals was present during this debate. This debate was about the future of the Klaipeda’s Hospitals and the unanimous decision of the forum was that there is the obvious need to establish Klaipeda’s' University Hospital. A representative of the Ministry of Health, Mr. Martynas Marcinkevicius who gave a presentation during this event supported this idea. There have been no developments since then.

The “fight” continues.