2026-06-10
- Patient transportation services provided by the Emergency Medical Service (EMS) were charged at rates higher than those permitted by law.
- In some months, administrative costs accounted for up to 85% of the price of transportation services.
- There were instances where a single kilometre of transportation cost the state 159 euros.
- A quarter of the funding allocated for 2025 was used to cover debts from previous years.
- EMS received additional funding from the CHIF reserve despite a fixed profit of EUR 2.2 million.
The patient transportation system was established to ensure that people who are unable to travel to healthcare institutions on their own can reach them more easily. However, the financial audit of the 2025 set of accounts of the State conducted by the National Audit Office revealed that the organisation and financing of this service did not ensure the rational use of state funds. In some months, the administration of the patient transportation service cost several times more than the actual transportation of patients, the pricing of patient transportation services was unclear, controls were insufficient, and the auditors were unable to confirm the legal and economic justification of the patient transportation services organised by the Emergency Medical Service (EMS) and paid for from the state budget.
“The patient transportation service must ensure assistance to people, not generate excessive administrative and logistical costs, when the state pays hundreds or even thousands of euros for a short ride because a car is dispatched from the other end of Lithuania. In the healthcare system, every euro must create value for the patient, so the organisation of services must be based on clear accountability, reasonable costs, and transparent decisions. I therefore urge decision-makers to seek an answer to the fundamental question: why was this particular centralised model chosen, and would it not be more appropriate to decentralise it to the local government level, where decisions would be made closer to the patient, more flexibly, and more rationally?” – emphasises Auditor General Irena Segalovičienė.
Service administration is more expensive than the services themselves
The audit revealed that a significant portion of the funding was allocated not to the transportation of patients itself, but to the administration of the service. From July to October 2025, the costs of administering patient transportation service orders accounted for 75 to 85 percent of the total appropriations allocated for patient transport in the respective month. The Ministry of Health (MoH) had not established a mechanism to control these costs.
Furthermore, in cases where EMS provided transportation services itself, a portion of the indirect administrative costs was reimbursed separately, so the actual administrative costs were even higher than those indicated by the official administrative cost data.
In the National Audit Office’s assessment, the current service organisation model was not adapted to the actual volume of services and did not ensure the efficient use of public funds.
Service fees are higher than those specified in the legislation
The audit revealed that the pricing of patient transportation services was not managed properly. Although the EMS does not have the authority to independently set or change the price of services funded by the state budget, between October and December 2025, the service applied its own approved rate of 104 euros per hour which is nearly 29 euros more than the 75.14-euro rate established by law. As a result, in just three months, 21,100 euros of state budget appropriations were used unjustifiably.
The auditors identified further shortcomings in pricing. It was unclear whether the price of the services included all costs related to their organisation, and some indirect costs may have been reimbursed twice. This increased the risk that state funds for patient transportation services were not used transparently and efficiently enough.
A single patient transportation cost 1,355 euros
The audit results show that patient transportation services were organized inefficiently in some cases. The auditors identified cases where service providers travelled from distant cities, even though patients were transported over relatively short distances. As a result, a significant portion of the service cost was attributable not to the transportation itself, but to the carrier’s trip to and from the patient.
One example involved a patient in Vilnius who was transported a distance of 1.1 km, but the vehicle providing the service came from Elektrėnai. The total distance travelled was 72 km, while the cost of the actual 1.1 km transport service was 159 euros. In another case, to transport a patient from Palanga to Mažeikiai (109 km), the service provider also travelled from Elektrėnai. The total distance travelled was 670 km, and the cost of the service was 1,355 euros.
This indicates that the current model for organising patient transportation does not ensure the efficient use of public funds and is not geared toward economical service provision.
Shortcomings in the payment of services and questionable additional funding
The audit found that of the EUR 7.76 million allocated for patient transportation services in 2025, EUR 1.98 million was used to pay for services provided in 2024, even though the funding was intended only for services in 2025.
At the end of 2025, an additional EUR 6.2 million was allocated to EMS from the reserve funds of the Compulsory Health Insurance Fund to reduce credit debt. However, in the same year, the service recorded a surplus of EUR 2.2 million from its core operations.
The audit report notes that decisions regarding additional funding may have been made without properly assessing the service’s actual financial situation, results of activity, and available resources.
Unclear division of responsibilities between the State and municipalities
The auditors note that the current regulations governing patient transportation do not clearly define the responsibilities of the state and municipalities in organising these services. As a result, some patient transportation services are funded and organised at the state level, even though, according to the law, they may fall under the responsibilities of municipalities.
In the National Audit Office’s assessment, the unclear division of functions and funding responsibilities hinders the efficient organisation of services, increases administrative costs, and raises the risk that state budget allocations will be used inefficiently.
The National Audit Office recommends clarifying responsibilities and reviewing pricing
The National Audit Office recommended that the MoH systematically assess the legal regulation of the organisation and provision of patient transportation services, clearly define the responsibilities of the state and municipalities, and introduce a pricing system for services and their administration based on actual costs.
Implementing these recommendations would more clearly divide the responsibilities of the state and municipalities in organising patient transportation services, and the pricing of services and their administration would be based on actual costs. This would allow for more efficient use of state funds, reduce the risk of unjustified expenses, and ensure more transparent organisation of patient transportation services.