After reviewing the State Audit Office’s report on the planning of inpatient healthcare, the Latvian Health and Social Care Workers’ Trade Union (LVSADA) identified numerous “serious shortcomings,” the union announced.
According to LVSADA, the very aim of the audit – “to assess whether inpatient healthcare is being planned and organized in line with needs and in the best possible way” – contains “not a single word about available resources.”
The union points out that the report acknowledges “the limited funding of inpatient healthcare is the main factor preventing services from being planned according to patient needs.” Nevertheless, auditors still claim that inpatient healthcare services are planned and financed without taking patient needs into account.
LVSADA also argues that the report is full of data that
“seems to obscure the lack of meaningful and objective research.”
For example, the National Health Service is criticized for not being able to specify during the audit how many minutes are required to provide inpatient healthcare. The conclusion drawn: “the justification for the wage element in the tariff cannot be traced.” LVSADA commented that such reasoning is as absurd as demanding a forester to state exactly how many needles and leaves are in a forest, and, failing to provide the number, accusing him of poor record-keeping. In the union’s view, this approach is “detached from reality and therefore categorically unacceptable.”
Another example criticized by LVSADA is the report’s statement that spending on medical staff salaries has increased by 24% since 2021. The union claims this fact is presented without context. During the same period, the average monthly salary in Latvia rose by 32%, according to the Central Statistical Bureau (CSB). This means the government has made healthcare wages even less competitive, LVSADA argues.
The union also disputes the report’s claim that from 2021 to 2024 hospital funding grew by an average of 8% annually, while hospitalizations increased by 4% annually. LVSADA highlights that the report “forgets to mention that consumer prices during the same period rose by 8.7% annually,” according to CSB data.
“Thus, the entire hospital system worked under increasing strain,
while the government financed it without even compensating for inflation!” LVSADA insists.
Union chairman Valdis Keris believes the State Audit Office’s report should be seen as the execution of a political “order” during the state budget drafting period. At the same time, it once again exposes the “critical shortage of working hands in state and municipal hospitals.”
The Latvian Hospital Association has also rejected the State Audit Office’s criticism of healthcare institutions, dismissing the accusations and arguing that the conclusions about inpatient facilities were drawn without an in-depth analysis of how they function within the broader healthcare system. The hospital network, they say, must be evaluated in relation to other healthcare components and structures, including primary and outpatient care, as well as public health indicators, income, mobility, and other factors.
The State Audit Office concluded that hospitals receive more than €700 million annually – around 40% of the healthcare budget – but the funding primarily sustains a fragmented hospital network rather than ensuring equal and high-quality care. The division of hospitals into levels is not functioning, tariffs are outdated and merely adjusted mathematically to available funds, and there is internal unfairness in financing, which most severely impacts top-level hospitals.
The Ministry of Health (MoH) has promised to address the problems identified in the audit
by reviewing the hospital network and the range of services provided.
According to the MoH, the plan is to restructure the hospital network to create a unified, functional, and cooperation-based system. University hospitals would serve as leading centers, providing methodological guidance and quality control. Hospitals would have clearly defined service baskets and quality criteria for treatment profiles. The system would also include a “developed mental health ecosystem,” care for chronic patients, rehabilitation, and hospice services.
Based on the conclusions of the audit and pilot projects, the MoH plans to review inpatient service profiles, define requirements for inpatient care, and develop a model for hospital cooperation networks drawing on international experience.
A revision of the financing model is also planned, with the aim of promoting efficiency and quality, the ministry promised.