2013-03-12
National Audit Office: There is no shortage of family doctors in the country, however, they do not satisfy the needs of the population
Visits to family doctors (general practitioners) account for two-thirds of all visits to doctors. Family doctors offer primary health care services to more than 2.5 million people. These services are provided by almost two thousand family doctors in 164 public and 237 private medical institutions which have agreements with territorial health insurance funds. The annual amount of funds allocated from the Compulsory Health Insurance Fund for the payment of outpatient services provided by family doctors totals about LTL 600 million.
The National Audit Office conducted an audit to assess effectiveness of the functioning of the family doctor’s institution. Auditor General Ms Giedrė Švedienė commented on the audit findings as follows: “The funding of primary health care is deemed to be a priority area, and the amount of funds allocated for this purpose has not been decreasing despite the declining population number in the country; however, the key problems in this area still have not been resolved – family doctor’s services are not equally accessible to all inhabitants, there is uneven distribution of doctors in municipalities. In addition, family doctors do not carry out all duties imposed upon them and do not use all their competencies when examining and treating patients.”
The shortage of doctors is especially acute in six municipalities of the country, meanwhile in 34 municipalities they are too numerous. 37 per cent of family doctors have more patients and 18 per cent – less patients than it is established in a regulatory document. However, where there are very few patients, it is still not easy to see the doctor because they do not work full-time or every day. Besides, family doctors spend almost a quarter of their working time for performing functions which do not require doctor's qualification. As a result, they work insufficiently effectively, devoting less time to diagnostic and therapeutic work and failing to fulfil other functions which require doctor's qualification.
The Ministry of Health has no accurate data on the demand of family doctors and does not perform long-term planning. In the absence of the established (mandatory) demand planning criteria, the number indicated by municipalities is not always precise. Also, municipalities are insufficiently effective in implementing measures to alleviate the shortage of family doctors. Although the number of family doctors who completed residency in 2012 increased more than double as compared to 2010, over half of young family doctors got employed in the major cities of the country. Therefore, the shortage of family doctors in the municipalities with the highest demand has not been overcome.
The auditors found that only less than one-third of the surveyed doctors perform all competencies established in the Medical normative standard on the family doctor. Four fifths of the family doctors who responded to the question whether they reasonably sent patients for consultation to specialised doctors pointed out that they do this without having used all their competencies in the patient examination and treatment area.
All population covered with compulsory health insurance may receive non-infectious disease prevention and control services free of charge. However, family doctors perform very few such health checks. The auditors found that few medical institutions inform population about the availability of these services – only 7 institutions out of 131 provide such information on their website. As a result, in 2011 only 5 per cent of 1.7 million adult patients who visited family doctors had medical checks for non-infectious diseases.
The audit also revealed that family doctor’s qualification in medical institutions is not valued, no areas for its improvement have been established. The qualification improvement which is offered usually does not meet the needs of the family doctor, and there is very little practical training.
With a view to ensuring that family doctors better meet the needs of the population and that family doctors’ competencies are better performed, the National Audit Office made recommendations to the Ministry of Health and other institutions and bodies.