Latvian healthcare disaster, part 4

"Recipe plus", the largest Latvian wholesaler of drugs, stops the supply of drugs to Stradins Clinical University Hospital, one of the two largest hospitals in Latvia, due to the hospital being 0.9 million lats (1.3 million euros) behind in payments.

Other hospitals are badly behind with their payments to suppliers and risk being cut off, as well. The healthcare budget cuts are making the system to fall apart.

Latvian healthcare disaster, part 3

According to this article (Latvian, Google translation), Riga 1st hospital will be only able to treat 10 emergency patients per day:

According to the 2009 plan of VOAVA (the Latvian government agency that
contracts with hospitals), there will be money for treating 16,000 patients.
Since 14,070 patients have already been treated until July 15, this means that,
in the 169 days until the end of the year, the hospital can treat 11.6 patients
per day.

The healthcare tragedy gets worse every day.

Latvian healthcare disaster, continued

Here are two more newspaper stories on the healthcare disaster that is unfolding in Latvia:

• "Possible solution: government pays for only two days in hospital": Latvian, Google translation.
• "Cardiovascular surgeons: government's attitude will condemn 2000 people a year to death or disability": Latvian, Google translation.

To summarize the two articles, the Latvian hospital funding has been cut by 57%. P. Stradins Clinical University Hospital, one of two main hospitals in the country, has its funding cut by 75%. Hospital's chairman of the board, Arnolds Atis Veinbergs, says:

With this funding, we can provide emergency care until the end of September
or early October.

All government-funded planned non-emergency care has been suspended. Patients with tumors can no longer get tests whether the tumors are cancerous (unless they pay the entire price of the test themselves). Patients with major cardiovascular problems (such as aortic aneurysms, which have 90% chance of death if the aneurysm ruptures) can no longer get scheduled surgery that would fix their problem. Cardiovascular surgeons estimate that this would lead to 100 more people dying from aortic aneurysms and 2000 more people dying from other cardiovascular problems that could have been treated.

The healthcare cuts are going to have an extremely heavy toll. Couldn't our government find anything else to cut?

Latvian healthcare disaster

After the most recent round of budget cuts, which removed 25% of the healthcare funding for the 2nd half of 2009, our healthcare system is rapidly falling apart.

The hospital funding has been cut even worse and currently stands at 43% of the 1st half-year level. 29 local hospitals have been closed in April 2009 or will be closed in September 2009.

And, even the hospitals, which are not closing, are admitting only two categories of patients: people who pay for full cost of treatments themselves or patients who are in life-threatening condition. If someone can't pay, they have to wait until their disease deteriorates to a life-threatening stage.

Welcome to hell.lv!

The worst of the cuts

It's 3 days since the last budget proposal is out. So far, most of the public anger has concentrated on the cuts in the retirement benefits (70% for working retirees, 10% for the rest). But there are far worse things in the proposal.

The budget for healthcare services (hospitals, doctors, etc.) is being cut by 42 million lats. If we look at the previous version of the budget, there were 336 mln lats for healthcare. About half of that has been spent in the first half-year - which means that there is about 168 mln left for the second half year. The amount that is being cut is 25% of the entire budget!

I don't know how our healthcare system will survive that. In many other parts of public sector (for example, education or public administration), the main costs are salaries and 25% cut means 25% (or slightly more) off from salaries. Healthcare has many non-salary costs: medical equipment (and, even if hospitals don't buy new equipment, they still have to pay off loans for the equipment bought in the "fat years" of 2005-2007), medicines, etc. Does one stop giving drugs to patients? Or does one cut salaries of doctors and nurses by 40-50-60% to achieve a 25% cut in total costs?

Healthcare Ministry official proposes higher payments from the patients themselves:

For example, if the medical investigation costs 50 lats (70 euros), the
patient pays half, the government pays half.

This also looks like a non-starter, since many people don't have 25 lats. If someone is earning the minimum salary, it takes them almost a week to earn 25 lats and there are so many other costs! Same about retirees (the average retirement benefit in Latvia is about 170 lats/month). And unemployed. And many other categories of people.

There was a previous increase in the patient co-payments in March and hospitals reported that many people started coming in only when their disease has progressed to an unbearable condition. What's next?

Complete craziness

Latvian government is having to choose between several ways to balance the budget, which all look equally crazy. The first proposal, on Monday:

• 20% cut in all public sector salaries (on top of earlier 15-35% cuts);
• VAT increase from 21% to 23%;
• introduction of progressive income tax, starting with income of 300 lats/month (430 euros/month!) which would be taxed at 29% (instead of current 23%) plus the social security tax;
• the income tax on incomes above 800 lats/month (1150 euros/month) would increase from 23% to 40% (also not including the social security tax);
• many smaller cuts and tax increases.

The second, yesterday:

• no tax increases, except for alcohol tax, but
• 40% cut in public sector salaries (on top of earlier 15-35% cuts);
• 10% cut in retirement benefits;
• many smaller cuts.

Either way, it's crazy. Crazy tax increases or crazy salary cuts.

And the craziest of all things. Either of those two proposals only brings Latvia to a budget deficit of 5-6% of GDP. Next year, more cuts or tax increases will be needed. Can a country run out of salaries to cut or taxes to increase?

Latvian students protest education cuts

DPA has a story on Latvian student protests. A few quotes:

Outside Riga Technical University, tourists looked on bemused as woodwork students expertly fashioned bird boxes which they claimed was the only affordable housing available to them.

"The government is going to cut the budget for higher education again by 40 per cent on top of earlier cuts. At the beginning of this year there was a cut of about 34 per cent so today we are holding our first demonstration," Avots said.

40 per cent cut on top of an earlier 34 per cent cut - that means that higher education budget would now be cut by a total of 60%. In other words, only 40% of the budget would remaining. It's becoming quite crazy here, in Latvia.

The full DPA story is here.

Latvian tragedy

Saturday's Diena has a poignant article (in Latvian). Short summary in English:

A 21-year old Latvian suffering from chronic liver disease (primary sclerosing cholangitis) was waiting for a liver transplant. That would be the first liver transplant performed in Latvia.

The operation was planned for December 2008. Then postponed to March 2009. Then, due to the economic crisis and the healthcare budget cuts, postponed again. The patient was suggested to seek a treatment abroad. Which would cost 80000 Euros which the patient did not have.

Three weeks later, he committed suicide by jumping from a 6th floor window.

The budget cuts are taking their toll. Sometimes, it's a very heavy toll.

Here is the Google translation of the story to English. With some mistakes and untranslated words, but readable.

Signs of crisis in everyday life

A Latvian college whose funding has been cut by 30-something % cuts off the hot water in the student dormitories:

Translation of the sign:

"Attention! From now on, hot water will be supplied only on Wednesdays from 15:00 to 23:00. Administration of [name of the institution]"

There are multiple reports of this happening in different places. And there are many more reports of heating turned off/down in classrooms and students sitting in classes in coats.