Kristīne Jučkoviča

Although I visit the dentist regularly, I recently experienced something I wouldn’t wish on my worst enemy – I broke a piece of my front tooth. My dentist was not available right away, but after talking to some healthcare master’s students, whom I had examined on that unfortunate day, I found another dentist and the problem was soon solved. However, there was one more place I had to go with a gapped smile – to school, to a career day lecture, where I heard from a career consultant that “teachers walk around like that for months.” Teachers, civil servants, whose salaries generally come from the state budget. I don’t believe that anyone would willingly walk around with a broken front tooth, especially in a profession where being in the spotlight is part of everyday life.

Health care is my first field of education. I have been following the field from various perspectives since 1993. The main conclusion is that the health care sector is subject to public pressure. Society points out shortcomings and problems, criticizes, gets involved and pushes forward. Politicians – at least those who want quick popularity – rush to comply. Can healthcare be systematically organized in this way? This is not a rhetorical question, so I will answer immediately: no.

Government declarations mostly say the right things – health care must be patient-oriented, services must be developed and improved, accessibility and treatment are necessary, and everyone should have more healthy years of life. However, despite this, health care has been plagued by a lack of money for decades. It doesn’t matter whether it has been a priority or not. Incidentally, I once asked the same students whether any of them felt in their work experience that health care had been a priority in the country in 2024. The answer is easy to guess.

If we look back at the past year, there has been a huge dissonance between what we have seen on TV screens and social media and real life.

There have been issues that have been addressed immediately – due to the aforementioned public pressure – such as increased individual compensation for patients who are not covered by the system and the pricing of medicines being moved towards greater state compensation. All of this is good. But is it right if we want good governance of the system? At the same time, a senselessly rushed reform of medicine mark-ups has been pushed through. We will only see what this will bring, at the earliest, in March next year. Most likely, it will not lead to lower drug prices. I predict that it will lead to a desertification of pharmacies* and much lower availability of drugs for the population, if only because the discussions with the industry have been declarative and there are no plans to correct the mistakes quickly. Incidentally, in comparison with our neighbor Estonia, where every year a document is published setting out the goals and objectives for health care as a sector, all participants and users in the sector can clearly see the direction and path the sector is taking. In Latvia, we are going down the wrong path – we write one thing and do another. To be clear, however, there have also been gaps in Estonia’s health care budget, and our neighbors will meet their health care budget for 2025 by significantly increasing fees for health care services and co-payments for prescription drugs. What will we do? I don’t know – that would be my answer. Will we change the healthcare financing law? What will it look like? Will it fill the budget? How else will we increase the shrinking healthcare budget – most likely, it will continue to shrink for at least the next three years. Will we carry out reforms after the reforms? What will we change? For what purpose?

Undeniably, the health care sector is inherently complex. It not only provides treatment and care, but also digitizes (admittedly, highly educated pharmacists will soon become computer operators, entering paper prescriptions into the system) and builds hospitals, some of which have already been started but will most likely never be completed, while others will never even get off the ground because builders have not committed, which means that the state will lose money. And these are just a few examples.

For the health care system to function successfully and be able to compete with the best, cooperation between the state, non-governmental organizations, the private sector and patients is essential. Yes, opinions are being listened to, thank you. But are they taken into account? How can trust in public administration be built if processes that are perfectly defined at the national level are not implemented in real life because the objections of entire sectors to fundamentally new regulations are not taken into account not only by ministries, but even at the level of the Cabinet of Ministers, just as the latest amended agreements and reforms are regularly sent out shortly before Christmas, Easter, Midsummer, etc. How can a country develop if all forms of entrepreneurship are being hampered, contrary to the provisions of the Commercial Law?

Healthcare is like my front tooth that fell out prematurely. It has been repaired and looks like new in the mirror. However, I cannot chew with it. The dentist recommends that I will eventually need either a new crown or an implant. At a much higher cost.

The Latvian public has just donated a million euros to a charity campaign for those whose treatment is not covered by the state. Will the Latvian people have a million next year? And the year after that? Or should we start from scratch, for example, by taking care of people in family doctor’s offices, so that every senior citizen, when leaving the doctor’s office, knows when and where to go and how much they will have to pay for health services.

It is also high time to take action to organize a sustainable health care system that is relevant to the population, which is an urgent priority in today’s geopolitical situation. With an aggressive neighbor, we are in a direct crisis zone, so we must be prepared for various scenarios. Within the sector, the private sector currently seems better prepared for crisis situations than the public administration.

The health care sector employs outstanding professionals, including in health management. Associations, unions, societies and private entrepreneurs have chosen to devote their energy and time to this country, our Latvia. I urge you to use the resources available to this country wisely and effectively. We can start with the next year, 2025.

The author is the founder and board member of the think tank Healthcare System Sustainability and the executive director of the Latvian Pharmaceutical Care Association.

* Places and areas where pharmacy services are not available.