Barriers to accessing adequate maternal care in Latvia: A mixed-method study among women, providers and decision-makers.

INTRODUCTION: Latvia has a high maternal mortality ratio compared to other European countries, as well as major inequities in accessing adequate maternal care. Adequacy refers to the extent to which services are safe, effective, timely, efficient, equitable and people-centred. This study aims to explore stakeholder views on access to adequate maternal care in Latvia and the extent to which there was consensus. METHODS: This mixed-method study is based on an online survey among women who recently gave birth, as well as interviews with healthcare providers and decision-makers. The data were analysed using the method of directed qualitative content analysis. The extent of stakeholder consensus was determined by studying five access-related aspects of maternal care: availability, adequacy, affordability, approachability and acceptability. FINDINGS: Our study identified barriers to accessing adequate maternal care related to availability (i.e. shortage of human resources, geographical distance) and appropriateness (i.e. inequalities in provider knowledge, care provision and use of clinical guidelines). Other challenges were related to providers' approaches towards women (i.e. communication) and, to a lesser extent, maternal care acceptance by women (i.e. health literacy). CONCLUSIONS: The barriers identified in our study highlight areas that should be addressed in future reforms of maternal care. These barriers also indicate the need for micro-level indicators that can facilitate a comprehensive evaluation of maternal care in Latvia and elsewhere

Public preferences for vaccination campaigns in the COVID-19 endemic phase: insights from the VaxPref database

Objective Despite widespread perceptions that SARS-CoV-2 (COVID-19) is no longer a significant threat, the virus continues to loom, and new variants may require renewed efforts to control its spread. Understanding how individual preferences and attitudes influence vaccination behaviour and policy compliance in light of the endemic phase is crucial in preparation for this scenario. Method This paper presents descriptive data from a global stated choice survey conducted in 22 countries across 6 different continents between July 2022 and August 2023, and reports the methodological work developed to address the need for comparable data. Results This study included 50,242 respondents. Findings indicated significant heterogeneity across countries in terms of vaccination status and willingness to accept boosters. Vaccine hesitancy and refusal were driven by lower trust in public health bodies, younger age, and lower educational levels. Refusers and hesitant people reported lower willingness to take risks compared to those fully vaccinated (p<0.05). Lower mental health levels were found for the hesitant cohort (p<0.05). Conclusions Insights from this database can help public health authorities to gain a new understanding of the vaccine hesitancy phenomenon, support them in managing the transition from the pandemic to the endemic phase, and favour a new stream of research to maximise behavioural response to vaccination programs in preparation of future pandemics

Inequalities in actual patient payments, willingness and ability to pay

In Lithuania, out-of-pocket patient payments (OOP) in health sector have been the focus of political debates for many years. Pharmaceutical costs constitute a major share of private expenditure on health. However, the OOPs for services both official and unofficial (including quasi official) are significant. The aim of the paper is to present the outcomes of the analysis addressed to patient’s characteristics influencing the OOPs for health services and individual willingness to pay (WTP) as well as inequality dimensions of the OOPs in Lithuania. It is the first outcome of the analysis of the data collected in July, 2010, within the international collaborative project “Assessment of patient payment policies and projection of their efficiency, equity and quality effects. The case of Central and Eastern Europe”. The study was financed by the European Commission under FP7 Theme 8 Socio-economic Sciences and Humanities, Project ASSPRO CEE 2007 (GA no. 217431). The content of the publication is the sole responsibility of the author and it in no way represents the views of the Commission or its services. The data on the OOPs were collected through a nationally representative survey (N=1012) in July, 2010, using face-to-face interviews based on a standardized questionnaire. The questionnaire was discussed with external experts and pre-tested in a pilot study. During the period of July, 2009 – June, 2010, patients spent on average 146 litas7 for health services or, recalculated for those, who actually paid for the services (about 37% of adult population), 325 litas. Official average payment for outpatient consultation equals 64.6 litas, unofficial one – 72.8 litas. Despite negligible private provision of inpatient services and the declared “all included” hospital services, official average payment in hospital was about 246 (7–200) litas; unofficial payments for inpatient services were the most frequent within the corresponding patients’ group, when almost a half of the patients paid 158 (0.5–1600) litas per hospitalization. Males and the poorest population paid for healthcare less frequently in opposite to more frequent payments among those, who were not satisfied with the quality of the services. Moreover, almost 58 percent of the population agreed to pay officially for better quality services in a case of facing serious threat to their health. In less severe cases, the WTP was even higher when 82 percent, and 71 percent of the respondents agreed to pay officially on average 42 litas and 355 litas for outpatient and inpatient services, respectively. The WTP for the outpatient services was the lowest among the poorest and country-side citizens, as well as those, who had a lower education level. At the same time, living in cities, single persons and those, who had not paid for inpatient services, were determinants for reducing the WTP for the inpatient services. [...]Lietuvoje pacientų mokėjimai už sveikatos priežiūros paslaugas periodiškai tampa viešų diskusijų dalyku. Tyrimo tikslas – išanalizuoti vartotojų charakteristikas, kurios turi įtakos tiesioginiams mokėjimams bei sutikimui mokėti, taip pat nelygybės tiesiogiai mokant už sveikatos paslaugas pasireiškimus. Tyrimas atliktas taikant suaugusių Lietuvos gyventojų (N =1012) 2010 m. apklausos duomenų statistinės analizės metodus. Įvertinti faktinių mokėjimų dydžiai ir juos mokėjusių gyventojų charakteristikos. Pateikti nelygybių, mokant už sveikatos priežiūros paslaugas, įrodymai. Nagrinėjami veiksniai, turintys įtakos sprendimams naudotis mokamomis paslaugomis

The Opinions of the key health care stakeholders towards patient payments in Lithuania

Patient payments are considered to be a significant issue in health policy in Lithuania. Despite the unclear legislative framework, health care institutions are asking patients to co-pay (contribute) for services provided to them. Thus, patients and providers are facing challenging situation in legal, ethical and financial terms. The aim of the study was to evaluate the opinions and attitudes towards patient payments in Lithuania. Qualitative and quantitative research methods were applied in the study – focus group discussions and in-depth interviews combined with a self-administrated questionnaire filled in by each participant. The results suggest that there is no consistent policy on patient payments in Lithuania. Health care consumers are rather resistant towards the introduction of payments (they support fees only in case of services with better quality). Health care providers sustain patient payments considering the needs of health professionals and health care institutions. Health policy makers and health insurance representatives remain dispersal in their opinions. More conceptual and strategic thinking in defining the aims of patient payment policies in Lithuania and its governance is needed

Iššūkiai įgyvendinant Lietuvos psichikos sveikatos politiką : mokslo studija

Recenzavo: prof., habil. dr. Ž. Padaiga (Lietuvos sveikatos mokslų universitetas); dr. G. Baltrušaitytė (Vytauto Didžiojo universitetas)Tyrimo tikslas buvo kompleksiškai išanalizuoti Lietuvos psichikos sveikatos politikos formavimo ir įgyvendinimo raidą 1990–2013 metais bei moksliškai įvertinti jos veiksmingumą. Pasitelkus sisteminės analizės paradigmą ir realistinio vertinimo metodinę prieigą, vykdyta kompleksinė analizė (ekspertų interviu, pirminių ir antrinių dokumentų analizė, turinio ir diskurso analizė). Buvo analizuojamas tiek su visuomenės psichikos sveikatos problemų sprendimu susijęs socialinis (žiniasklaidos šaltiniai) ir politinis (Lietuvos Respublikos Seimo stenogramos) diskursas, tiek psichikos sveikatos politikos ir psichikos sveikatos priežiūros sistemos veiksmingumas. Rezultatai. Analizė atskleidė, kad Lietuvos psichikos sveikatos politikoje šiuolaikiniai mokslo žiniomis grįsti principai yra tinkamai suformuluoti, tačiau nėra įgyvendinami, todėl Lietuvos psichikos sveikatos politika negali būti laikoma veiksminga. Aptiktas visuomenės nuostatų, valdžios institucijų sprendimų ir psichikos sveikatos priežiūros sistemos veikimo bei vertinimo būdų nepalankus derinys, kuris veikia ydingo rato principu. Išsiaiškintos šios svarbiausios ydingo rato mechanizmo grandys, veikiančios tuo pačiu metu ir kaip nepalankių reiškinių bei rodiklių priežastys, ir kaip jų pasekmės: valstybės biudžeto, PSDF ir ES fondų lėšos daugiausia investuojamos į ankstesnių tradicijų suformuotą paslaugų sistemą, stiprinančią socialinės atskirties, stigmatizacijos ir bejėgiškumo reiškinius; sustabdyta arba pernelyg lėta veiksmingų visuomenės sveikatos intervencijų ir psichosocialinių bendruomeninių technologijų plėtra; neveikia sistemos ir jos atskirų grandžių nepriklausomo vertinimo mecahnizmai; visuomenės psichikos sveikatos rodikliai yra nuolat prasti.[...]Politologijos katedraVilniaus universitetasVytauto Didžiojo universiteta