Andrejs Pantelejevs, head of bureau of the Ministry of Health of Latvia, discusses the importance of channeling the recent EUR 200 million healthcare financing to raising the wages of practitioners, reimbursing expensive innovative medicines in therapeutic areas such as oncology and cardiovascular diseases as well as strengthening e-health.
Can you please introduce yourself and your role as Head of Bureau of the Ministry of Health?
“In general, the Latvian pharmaceutical market is very small and often, given its size, is not very easy to negotiate prices.”
I joined the Ministry of Health four months ago from the Ministry of Defence. Prior to this I worked as a parliamentary secretary for about two years and then I was asked to set up a minister’s bureau. The minister’s bureau is a political body which is made up of advisers for the minister and my task is to organize the minister’s schedule along with liaising with the state’s secretary and the Prime Minister.
What were your first impressions of this role and how does it compare to the department of defence?
To be extremely frank, I thought it was about time to seize a new opportunity. I found everyone very disciplined and there were no ground-breaking problems to be solved. For someone who has worked in politics since the early 90s, going the extra mile and looking for challenges is of fundamental importance. In the healthcare system in Latvia, accessibility (including affordability) of healthcare services is a topical policy issue. Among other things, we are trying to introduce a state insurance as well as e-health, which obviously represent a considerable challenge not only because of technological but also mentality hurdles.
The reputation of the Latvian healthcare system is that it has been under-funded. What do you see as the deficit in this matter, what are you trying to address and how do you intended to present the Ministry of Health in the right health?
As a matter of fact, people are unhappy with what they receive from the state. According to the vast majority of them, it is a state duty to provide citizens with healthcare. Of course, we have a robust private healthcare system, but it is expensive, and it only covers a small portion of the population. On a similar note, we lost doctors who decided to leave the country because of dismal salaries and working conditions. While last year the government decided that healthcare financing should be increased by EUR 200 million, I am sure that soon we will be coping with people’s expectations to see miracles happening in a very short time.
In addition to the investment, mandatory social insurance contributions were raised by 1 percent and have been used to finance the healthcare sector as of January 2018. We have a big task to manage citizens’ expectations and explain them how soon they can expect the desired benefits to materialize. Last but not least, the upcoming October elections will be a bit of a crunch moment for us as the citizens will want to know where this money has gone to by then. Our main focus, nonetheless, is to channel these funds to raise wages of practitioners as they are the main pillars of a well-functioning healthcare system. Secondly, we will use the funds to reimburse innovative medicines, especially in therapeutic areas like oncology and cardiovascular diseases. Thirdly, we aim to reduce waiting times for specialty practitioners. We truly hope that we will manage to attract doctors back to Latvia as we are experience a great lack.
Raising the salaries of medical professionals might not be enough, as you have Scandinavia in the backyard with salaries much higher than you would be ever able to compete with. How can you incentive medical professions?
Doctors are not lacking in Riga, but mostly in the countryside. We are working together with municipalities to provide medical professionals with attractive packages, inclusive of housing and other compensations. Another aspect that we are actively working on is the restructuring of the hospital networks in the country. To give you an idea, in 2008 we had 72 hospitals, whereas now they decreased to 43 and we are still trying to focus on quality of treatments that citizens receive in these hospitals. Hospitals need to be given a special focus.
You mentioned that as a part of the EUR 200 million healthcare financing you will look to reimburse innovative and expensive cancer treatments. What is your relationship with the industry and how willing are you to finding common solutions for the sustainability of the health system?
In general, the Latvian pharmaceutical market is very small and often, given its size, is not very easy to negotiate prices. Sometimes there is just one company willing to tackle a specific disease burden and there is very little we can do. Because of the very size of the market we started thinking of common procurement between the Baltic states, but we also had preliminary discussions with Denmark and Spain.
On a similar note, what steps are you taking to promote preventive healthcare and early diagnostics?
Our current healthcare budget, although it was increased, is not even sufficient for those who are already on treatment. When it comes to preventive measures or promotion of a healthy life style, we hugely depend and rely on EU funds. They were distributed last year between municipalities and then together with the centre for disease prevention and control they have looked at ways to spend these funds. I must confess that I did not like the way resources were coordinated. Early diagnostics is of fundamental importance and this is definitely something that we will put on the government’s bill next year and make it a health priority.
Showing results and transparency with regards to the newly received funds is something you highlight quite extensively. E-health is actually the mechanism through which you can show that transparency and that the money is put to good use. What is the vision of the Ministry for e-health?
We have big plans when it comes to e-health. The development of an e-health system in Latvia brings about a transparent, clear and traceable healthcare system which is convenient for everyone – the patients and the doctors especially. However, we encountered some issues on the way. Firstly, we experienced technical problems when to many people use the online platform, secondly there was an issue with the hardware and thirdly there is also some resistance on behalf of the people who are not accustomed to dealing with online platforms. I am positive that we are in a right track to ameliorating the system, fixing all these bugs and educating the people to do it better.
How can you make the said reforms irreversible and not subject just to the political fluctuation?
This is not a concern to us because we have concrete reforms that have been accepted by the government. What is of vital importance for us is to carry out our tasks, produce results and have the public opinion on our side. The only guarantee for us is that, even if the ruling party in parliament should not be the same after the elections, MPs would not reverse any approved reforms. With regards to this, I would like to reiterate the importance for the Ministry of Health to have a strong public relations-oriented mindset throughout the year.
What is the key challenge ahead and what can we expect in terms of next steps?
Our main challenge is undoubtedly to implement our reforms but also to build a smooth and transparent where every citizen is fully aware of his/her rights within the healthcare system in Latvia.