Organising health care of statutory officers

In Lithuania, statutory officers are covered by compulsory health insurance; therefore, like the rest of the population, they are entitled to free health care services paid from the Compulsory Health Insurance Fund (CHIF) in the health care facility of their choice. The amount of compulsory health insurance contributions transferred to the CHIF for statutory officers in 2013 totalled LTL 92 million. Given the difficult and often dangerous work of officers, they are entitled to more free health care services (such as preventive health checks, consultations of specialist doctors, rehabilitation, etc.) than other residents. These health care services for officers are not covered from the CHIF but receive additional support from the state budget. About LTL 7.5 million are allocated every year for this purpose to the Ministry of the Interior which is responsible for organising the provision of health care services to officers.

“The Ministry of the Interior has failed to ensure cost-efficient use of state budget funds for the health care of officers and equal access of these services to all officers in the country,” said Auditor General Giedrė Švedienė commenting on the audit results.

According to the auditors, there is a lack of clear regulation of what health care services are to be financed from the state budget, so similar services in some cases are paid from the state budget and in other cases – from the CHIF. Prices of preventive health checks have not been fixed either (a similar check in the Medical Centre established by the Ministry of the Interior costs to the state twice more than checks in other health care facilities). There is no procedure set for officers' rehabilitation paid from the state budget instead of the CHIF, so it is not clear what rehabilitation services (and under what diseases) should be supported from the state budget and what the rehabilitation procedure is. Only clear identification of all health care services available to officers or cases of the provision of these services will explicitly show both to health care facilities and officers what services should be covered from the state budget or from the CHIF and for what services officers have to pay themselves.

Preventive health checks and immunoprophylaxis services are provided to officers at the Medical Centre in Vilnius and other health care facilities (in other five cities). However, these are the only services brought closer to their recipients. All other services which receive additional support from the state budget are provided to officers only in two facilities founded by the Ministry of the Interior, namely, the Medical Centre (all services are concentrated in Vilnius, with Kaunas having only a dental clinic) and Trakai Medical Rehabilitation Centre. Therefore, these services are mainly provided to officers living and/or working in Vilnius county. More than 90 per cent of the interviewed officers indicated that in case of health disorders they go to health care facilities located in their place of residence rather than those established by the Ministry of the Interior, because this is more convenient (you do not have to pay for the trip, spend extra time, etc.). For example, more than half of the interviewed officers who were entitled to rehabilitation services did not go to the institutions of the Ministry of the Interior simply because these facilities are too far away from their place of residence. Consequently, half of them had to pay for their rehabilitation in other health care facilities from their own funds.

The auditors noted that the institutions founded by the Ministry of the Interior should help implement only the functions assigned to the sphere of its activity, i.e. organise the provision of health care services additionally funded from the state budget to officers. The task of organising general personal health care has been assigned to municipalities and the Ministry of Health. However, the Medical Centre and Trakai Medical Rehabilitation Centre have been providing services to both officers and other persons. For example, Vilnius branch of the Medical Centre lists over 14 thousand patients and only 22 per cent of them are officers.

The National Audit Office issued recommendations to the Government, Ministry of the Interior,  and Ministry of Health to help ensure more cost-efficient use of state budget funds and more effective organisation of officers’ health care.