Publicatie datum

Organizational and structural changes in PHC centres during health care reform in Lithuania.

Liseckiene, I., Boerma, W., Milasauskiene, Z., Valius, L., Miseviciene, I., Groenewegen, P. Organizational and structural changes in PHC centres during health care reform in Lithuania. European Journal of General Practice: 2007, 13(2), p. 125-126. Abstract. European General Practice Research Network Meeting in Kavala, Greece, 19-22 October 2006.
Background: The increasing health care inequalities and morbidity, inefficient payment system challenged to a new health care reform with its priority primary health care after Lithuania’s independence in 1990. Former district doctors have been re-trained to become GPs and former policlinics have been modernized and decentralized. The private medicine was introduced. This paper is an evaluation of structural and organizational changes in PHC centres between 1994 and 2004. Research question: Are PHC centres better organized after PHC reform? Are there any differences between private and public PHC centres in 2004? Methods: In 1994 and 2004 identical questionnaires have been completed by random samples of primary care physicians about the: workload, working arrangement, practice equipment. Data entry, processing and analysis were carried out using SPSS software. Results: In 1994 the response among district doctors was 333 (87%) and among primary care pediatricians 262 (87%). In 2004 the response among GPs was 298 (73%). The number of the patients per GP decreased in 2004, but the number of office contacts, consultations by phone and workload increased in 2004. There were more equipment items in 2004. The number of home visits decreased in 2004. The distance of PHC centres were longer and there were less possibility to make an advanced appointment for a consultation in 1994. Comparing private and public PHC centres there were some differences: more patients per GP in public practice, but normal working hours higher in private PHC centres. The public PHC centres had more equipment. Conclusions: PHC centres are better organized then they were ten years ago. Private PHC centres have less equipment and less patients per GP, but private GPs have more time for their patients. Continued efforts, finance and time will be needed to reach the organization principles of western European countries.