Audrius Simaitis

VilNews invites you to participate in a discussion about Lithuania’s health care system.
Introduction by Audrius Simaitis,
Consultant Cardiologist at Royal Cornwall Hospital, UK.

One of the things that strikes one the most in Lithuania is the fact that management’s mentality in the health care system has undergone little change since Soviet times. This is out of proportion in comparison with other fields like education and business.

Any outsider would immediately ask: why?
The answer most probably could be found comparing the State owned medical field with the predominantly private sector of odontology.

The State owned medical field is ineffective, tarnished by corruption. National and European surveys reveal the public in general is significantly dissatisfied. Physicians are happy neither with salary levels nor with working conditions. The emigration rates of the doctors are increasingly in worrying proportions.

Odontology is the opposite. No corruption scandals, doctors are earning good salaries, customers are happy, and there is very little emigration amongst the dentists.

One country, two different worlds. Why?

The surveys regarding State owned medicine reveal that most people do not like the system; they do not understand the aim of the current reforms. At the same time people express very strong satisfaction rates with the particular care of the physicians and particular service provided by the Hospital. These kinds of answers mean one thing: people do not like the system, however they like the doctors. For the doctors it means a lot of personal effort to sustain the inefficient system.

The Swedish report in 2002 and The World Bank report in 2009 clearly indicated that problem too. The former report stated that the heads of the Hospitals demonstrated old - fashioned ways in dealing with their employees. In 2009 The World bank report came to the same conclusion emphasizing that there was obvious need to strengthen the management skills of those administering the Hospitals.

Very little if anything has been done since then. On the opposite, six years ago Parliament issued a law declaring 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. There is no control and accountability for their actions, as any of the Boards in the hospitals do not have any decision making power. As the result of that most of doctors and nurses live in apathy. They are disinterested in the health care system in general.

The Health Care ministry acknowledges this problem. There was a quite strong statement in the outline of the current reform in 2009. The Ministry states that there is a need to create collective ways of management to control the unilateral decisions of the Directors of the Hospitals. President Dalia Grybauskaite supports the idea of the rotation of the Directors.

Despite that very little progress was made towards the implementation of these ideas. In next 5-10 years health care systems of all countries will face an unprecedented challenge in the need of financial resources. There will be no more cash in the system. Therefore the only way to sustain the current levels of health care is through more efficient use of the resources.

This could only be achieved if ordinary doctors and nurses feel the interest and if they feel that they are a part of the system. With the current old-fashioned way the management does not allow that.

Therefore will Lithuanian health care be ready and able to live up to challenge in next five- ten years?