At a local tavern near where my small Overseas Adventure Travel cruise ship, the Clio, had docked in Riga, Latvia during a recent visit to Baltic countries, I sat down with Mr. Lauris Vidzis and Arturs Ozolins, MD to discuss medical care in Latvia as we enjoyed pizza and beer.
Mr. Vidzis holds an MBA and is the interim CEO of the Pauls Stradins Clinical University Hospital, the second largest system in Latvia with an 800-bed hospital in Riga. He had trained in hospital administration at Yale University, worked for a few years in the United States, then returned to Latvia with his wife and children. Dr. Ozolins is the head of the hospital’s hepatobiliary transplant department. Both of my new colleagues spoke English fluently.
Here is what I learned from my discussion with them about Latvia, which is bordered by Estonia on its north and Lithuania on its south. It is one of the three small Baltic countries closest to Russia and became independent of the Soviet Union on August 21, 1991.
We discovered Latvia and the U.S. share a common challenge: how to deliver quality medical care efficiently to all its residents. In 2022, the 1.88 million Latvians paid 12% of their GDP for medical care; in the U.S., the number was about 16.6%. The challenges of providing medical care to new immigrants is common in both countries; about 2.2% of Latvian residents are Ukrainians, some of which are emigrants from the Russian invasion.
Emergency departments in Latvian hospitals are overcrowded. The EDs in Latvia require co-payments ranging from four to 35 euros depending on the necessity of the service, with exemptions for disabled persons, organ donors, Chernobyl victims, and others. If the physician concludes that the ED visit was unnecessary (i.e., was not an emergency), the patient may end up paying for the services received starting from 50 up to 200 euros. However, this approach is complicated and patients often complain about it. One possible remedy we discussed was a solution common in the U.S.: urgent care centers and pre-visit emergency triage services, such as those provided by the Kaiser Permanente Medical Group
Apart from co-payments, the Latvian government pays for the medical care of its residents. Latvian universities train their physicians in all specialties. Medical training is almost free for medical students, but when completed, talented physicians must practice at a publicly sponsored hospital for several years so the Latvian government can recoup some of its educational investment. Following sufficient public service, private practice is allowed, initially on a part-time basis. Patients must pay for private care and private medical insurance is uncommon.
Waiting times for elective surgery at public hospitals can be as long as two years, such as for hip replacement and cataract surgery. Delays in access to care motivates wealthier Latvians to schedule procedures at private hospitals and clinics where the same surgeon who works part-time at a public hospital provides the surgery at the private facility.
Despite many challenges and scarce resources, Latvia has developed centers of excellence in several specialties, showing its leadership in the Baltic region. An example is the Latvian Centre for Cardiology at the Pauls Strandins Clinical University Hospital. Working in partnership with hospitals in Lithuania, Poland, Germany, the United Kingdom and others, it is a center for the diagnosis and treatment of rare cardiovascular conditions.
Market-driven retail payments support private care, both for affluent Latvians and medical tourists such as from the U.K. For example, Latvia offers a hospital dedicated to hip and knee transplants at a retail price of $7,000, including the surgeon’s fee. Additional costs apply for on-line consultations, prolonged stays in Latvia, and air fare. Latvian specialists also offer bariatric surgery for foreign patients. For more information contact ilva@nordmedtour.com.
About two-thirds of Latvian medical students are women. Latvia provides medical training for foreign students, who are mostly from Europe, with courses in English for international students. Latvian physicians are well-trained, motivated to excellence, digitally inclined, speak English, cherish their country’s self-determination, and share the same concerns as physicians in the U.S. Latvia has made amazing strides since gaining its independence from Russia.
With respect to social factors that impact health, Latvians incur a high number of injuries from driving scooters. Currently, far too few wear helmets while riding scooters. Helmets are optional. Despite many objections, the Latvian government backed the Ministry of Transport's suggestion that helmets should be mandatory in the future for young people riding a bike or electric scooter. City designs in Baltic countries promote walking, biking, and public transportation. Dedicated bike lanes are more extensive in Latvia than in Sacramento, but less robust than in Denmark, the “bicycle capital” of the Baltic.
Twenty-five percent of Latvians are obese compared with 40% in the U.S. I did not see any homeless tents or people begging for money at intersections. Compared to the U.S., reasonable gun control is more robust in all the Baltic countries we visited. In 2022, the murder rate in Latvia is 4.0 per 100,000 v. 6.3 in the U.S. and 0.86 in the EU on average.
My visit to Riga was part of a tour to seven countries bordering the Baltic Sea: Denmark, Poland, Lithuania, Latvia, Estonia, Finland, and Sweden.
The Baltic countries in general apply digital technology to daily life and delivery of public services. Latvians pay their income taxes and municipal transport electronically. Estonia, Latvia’s northern neighbor, considers itself the Silicon Valley of Europe and is a leader for the EU on protecting its systems from Russian cyber-attacks. Estonians vote digitally for national elections.
The people in the three small Baltic countries, Lithuania, Latvia, and Estonia, along with Poland, suffered terribly under Stalin and the Soviets. After World War II, the Russians occupied these countries for 35 years. The Soviet government sent most Latvian leaders and educated persons, including physicians, to Siberia for slave labor, sometimes until death. Latvia is still recovering from the oppressive Russian occupation after WWII and is rebuilding its infrastructure. For example, we visited a middle-class Latvian family for dinner at their home. They live in a pre-WWII single-family home, taken by the Soviets from its owner whose family was deported to Siberia for slave labor. Under Soviet occupation, six families lived in this home. Now, two families share the house, one on each floor with a lovely, shared garden.
Latvia, Lithuanian, Estonia, and Poland value their recent independence of the past 33 years. Their flat geography and ports on the Baltic make them vulnerable to an expected invasion from Russia if Ukraine falls. All seven countries displayed Ukrainian flags both officially and unofficially. Their citizens realize they cannot withstand an invasion without NATO. We met a reserve soldier with the Lithuanian Army whose government is actively securing its border in anticipation of a Russian invasion. Estonia and Latvia are doing the same.
I encourage our local medical students to consider a rotation in Latvia. Exposure to other cultures and methods to provide medical care is enlightening. Language is not a barrier because most Latvians understand English. If you’re interested, contact me for an introduction.
Email Gerald N. Rogan, MD
