Lietuvos sveikatos priežiūros paslaugų vartotojai ir teikėjai
LTVisos valstybės stengiasi patenkinti sveikatos ir sveikatos priežiūros poreikį. Kiekviena iš jų susiduria su pačia sudėtingiausia sveikatos priežiūros paslaugų rinkoje problema. Joms tenka nustatyti, kiek sveikatos priežiūros paklausa atspindi faktinį gyventojų sveikatos poreikį ir kaip tai priklauso nuo sveikatos priežiūros teikimo ir naudojimo. Sveikatos priežiūros paslaugų rinkos formavimas turi būti nukreiptas realiems sveikatos priežiūros poreikiams identifikuoti, pateisinamai paklausai tenkinti ir paskirtoms paslaugoms remti. Įvertinant sveikatos priežiūros paslaugų poreikį yra svarbūs sveikatos kiekio ir kokybės rodikliai. Pastarieji turi būti transformuojami į sveikatos priežiūros paslaugų pasiūlą.
ENAnalysis of statistical data allows to foresee that by 2003-2005 the number of Lithuanian population will become stable, and later it will start growing. I think that the process of the growth of Lithuanian population will be affected by the future positive migration balance (from 1992 negative migration balance is decreasing). The quick senescence process of Lithuanian population partially corresponds to the situation in the EU countries. As the process is taking place in conditions of low birth rate, its intensity should also be expected in the future. The foreseen growth of the number of population and its senescence changes in the future will predetermine social and economic problems, the growth of social security of population and health care needs. Despite the longer life expectancy of Lithuanian population, EU average hasn't yet been reached. Longer life expectancy, decrease in newborn babies' mortality, and good results of perinatal mortality in Lithuania show positive changes in social-economic situation. Low perinatal mortality also shows good quality of obstetrics and perinatal services. While evaluating mortality reasons in Lithuania, cardiovascular diseases, oncological diseases and accidents are singled out. As compared to other European countries, in Lithuania there is a high accident rate. Smoking is considered to be the main health risk factor. In Lithuania there exists health and health care inequity problem. Demand for health care services among different social groups docs not coincide. It partially depends on mortality and sickness rate differences. This has been acknowledged by most countries. Sickness rate differences in different countries are reflected in providing and financing health care services. The countries want to level the difference, yet it involves not only health care sector but also finance, education, unemployment and social politics.It is considered that progress of medicine, prevention, diagnosis, treatment and rehabilitation possibility increase in Lithuania will form demand for new health care services. The costs for provision and use of these services will be higher, without taking into account new cost-lowering medical technologies. The senescence process of Lithuanian population will stimulate expectations of the society and health care demand for high quality standardized services. The network of organizations providing health care services changed slightly. Changes of services provided were observed only in some institutions and enterprises. The number of general-purpose hospitals decreased and the number of nursing and rehabilitation hospitals increased respectively. After separating clinics from hospitals the number of organizations providing out-patient services increased. While analyzing the data of the main capital, its inadequate distribution was observed. The biggest part of the main capital is accumulated in Vilnius, Kaunas and Klaipeda city hospitals. Lithuanian physicians' labor market is monopolized, the main employer is MHC system, where in 1999 worked 83%, and in private practice were involved only 2,1% of Lithuanian physicians. In 1997-1998 decrease only in the number of privately working physicians was observed. Physicians explain it is due to decreasing salaries in private enterprises, insufficient demand for paid services and search for clients in state institutions providing health care services. A relative income decrease of Lithuanian population has a negative effect on private health care service market. Stomatologists (45%) and therapeutists (14%) form the biggest part of privately working physicians.A favorable credit system, permission for a privately working physician to buy premises in health centers, equal competition conditions for state and private organizations would stimulate the development of private physician's practice. Despite the great number of physicians observed already at the beginning of the reform, in eight years it was decreased by 3,5%. In achieving this goal it would be necessary to regulate the number of students entering higher medical institutions. In MHC system about 65% of working physicians provide outpatient services. General practitioners in Lithuania form a small number and serve 17% of the population. Establishment of GP institutions faced opposition of physicians. At the current re-qualification rate the process will be finished by the year 2005. 70% of interrogated Lithuanian physicians expressed dissatisfaction with their salary, more than a half indicated that work was being organized badly. When wanting to reach the average of the EU countries, the number of physicians working in Lithuania should decrease to 2 738, i.e. 18%, and the number of health care personnel should increase. Despite that, one shouldn't forget problems faced by some of the EU countries that had an insufficient number of physicians. The great number of physicians and small number of health care personnel reflects gaps in work organization and efficiency of Lithuanian institutions providing health care services. Health reform is being carried out especially fast in Lithuanian in-patient departments. The number of beds for one Lithuanian inhabitant has reached the level of 1965-1970. This coincides with the worldwide tendencies; however, it should be remembered that a GP institution having to undertake the biggest load has not yet been created. Despite the proclaimed lowering sickness rate, the number of people who visited and were treated at an in-patient department increases.
