The Baltic state of Latvia has a two-tier healthcare system, comprising both public and private provision. If you are planning to relocate to the country, your employer should sign you up with the national health insurance scheme. However, some expats choose to take out private cover, so that they can avoid long waiting times and access a higher standard of healthcare. Overall, the quality of healthcare in Latvia is not as high as in some of its European neighbours, although state efforts are being made to improve it.
Public healthcare in Latvia
The WHO reports that life expectancy at birth in Latvia was 74.8 years in 2015. This is up from 70.2 years in 2000, but is nearly six years below the EU average. There is also a huge gap in mortality rates by socioeconomic status. The life expectancy of Latvians, at the age of 25, with a low level of education is ten years lower than among those with a high level of education. This is largely due to higher death rates from heart attacks, strokes and lung cancer.
The WHO also says that the Latvian health system is underfunded. In 2015, Latvia spent €1071 per capita on health. This is the second lowest level in the EU, accounting for only 5.8% of GDP, compared with an EU average of 9.9%. Only 57% of health spending is publicly funded (compared to an EU average of 79%). Most of the remaining costs are paid out of pocket by households. This raises severe accessibility issues. Access to healthcare in Latvia is limited for a sizeable proportion of the population and is economically directed. In other words, poorer people have less access to medical treatment.
The leading cause of death for both sexes is cardiovascular disease. The second leading cause is cancer. Heart diseases and strokes have remained the two most common causes of death in Latvia since 2000. Together, they accounted for half of all deaths in 2014. Lung cancer is the most prevalent, due to high smoking rates. Deaths from diabetes also increased drastically between 2000 and 2014.
The state system covers:
- GP visits, including one annual preventative check-up
- Specialist visits
- Laboratory tests
- Home care
- Emergency medical assistance
- Hospital care
- Reimbursed prescriptions and medical devices
You will need to pay a fee to see a doctor, unless you are in one of the following categories:
- Under 18
- A pregnant woman being treated in connection with your pregnancy
- Certain groups of patients with particular diagnoses (tuberculosis, psychiatric diagnoses, certain infectious diseases)
For specialised medical care, you will need a referral from a doctor, usually your GP. However, depending on what disease you are suffering from, you may not need a referral to see any of the following:
- Children’s surgeon
- Addiction specialist
- Pneumonologist (lung doctor specialising in tuberculosis)
- Dermatovenerologist (skin doctor specialising in sexually transmitted diseases)
- Chemotherapy specialist
- Specialist in infectious diseases
The patient’s fee cannot be refunded in Latvia, which operates a benefit-in-kind healthcare system, meaning there is no system of reimbursement. However, you can claim reimbursement when you get home.
If you require hospital treatment, you will be charged a fee for in-patient treatment, starting from your second day of hospitalisation. You will not have to pay a fee if you are:
- Under 18
- Hospitalised because of pregnancy or childbirth
- Undergoing dialysis or some other treatments (e.g. for certain infectious diseases or mental illness)
There are additional fees for:
- CT scans (computed tomography)
- MRI scans (magnetic resonance imaging)
In addition to the patient’s fee, your healthcare provider may charge a co-payment sum for a surgical procedure carried out in an operating theatre.
As above, these payments cannot be refunded in Latvia, but you can claim reimbursement when you get home. You should only be charged the patient’s share of the treatment. Overall, costs are currently as follows:
- Out-patient examinations by a GP: €1.42
- Daycare in hospital: €7.11
- Specialist examinations: €4.27
- In-patient treatment: €10 a day, starting on the second day of hospitalisation
- In-patient treatment for patients suffering from oncological diseases and drug addictions: €7.11 a day, starting on the second day of hospitalisation
- In-patient treatment in a nursing home or nurse care unit: €7.11, starting on the second day of hospitalisation
Patients with certain medical conditions will pay reduced fees. Additional diagnostic examinations will cost between €1.42 and €35.57. In addition to the patient’s contribution, the healthcare provider may charge a co-payment of between €1.42 and €31. For example, this could be for CT scans, magnetic resonance imaging (MRI), electroencephalograms (EEG), electrocardiograms (EKG), X-rays, or an endoscopy.
You can also claim some of your prescription expenses from the NHS. Make sure your chosen pharmacy is under contract with the NHS. To buy prescription drugs, you need to show:
- Your EHIC (if you are from an EU member state and have an EHIC card)
- Your passport (or other form of identification)
- Your prescription (if you need prescription drugs that are not refunded by the state)
The state refunds 100%, 75% or 50% of the cost of prescription drugs, depending on the condition diagnosed. Again, you may also be able to claim reimbursement in your home nation.
State-funded dental care in Latvia is only available for children. Adults must pay for dental treatment, which is not refundable.
Private healthcare in Latvia
A hitherto poor level of investment in healthcare, resulting in standards that are still below those of other EU nations, mean that many expats opt for private health insurance.
Health insurance covers a full range of primary and secondary healthcare, as well as elective procedures, such as cosmetic surgery and more advanced dental treatment.
Experts point out that Latvia is well placed to be a destination for medical tourism. This is because it has an excellent reputation as a spa centre, particularly among Russians. It also has some high standard private medical facilities, which are very competitively priced.
As the country is becoming a destination for medical tourism, if you choose to access the private sector, you will find a wide range of treatments available. There are state, municipal and regional hospitals, private clinics, medical rehabilitation centres and resort hotels.
If you suffer from a chronic illness and are planning to move to Latvia, then your access to healthcare should be a key consideration. Latvia has a two-tier healthcare system, with both national healthcare and a private sector. Your entitlement to access public healthcare will depend to some extent on your country of origin. For example, if you are a member of an EU state, you will be able to use your EHIC. You will also have some options under the public system if you are British.
Many expats choose to take out private cover during their stay in Latvia, and you may wish to do this if you have a chronic condition. Although Latvia has universal healthcare, it does not rank well in terms of healthcare standards. We will look at some of your options below.
How does the Latvian healthcare system work?
If you are a permanent resident in Latvia, you are entitled to access state-funded healthcare under the same conditions as Latvian nationals.
Health insurance is applicable to all employees and self-employed persons who have made mandatory contributions, although there are some limited exceptions to this.
If you are a UK citizen, you may be entitled to state healthcare paid for by the UK. This will apply if you live in Latvia and receive:
- An exportable UK state pension
- A contribution-based employment support allowance
- Another exportable benefit
You will need to apply for a certificate of entitlement, known as an S1 certificate, and this will remain the case until the end of 2020 (and possibly beyond, depending on negotiations).
Note that if you are a UK citizen, you will not be allowed to use your EHIC card in Latvia.
The Latvian healthcare system and chronic illnesses
The leading cause of death among Latvian nationals is cardiovascular disease, and the second is cancer. Heart diseases and strokes have remained the two most common causes of mortality in Latvia since 2000, and they accounted for half of all deaths in 2014. Deaths from diabetes also increased drastically between 2000 and 2014. Chronic conditions afflict many people in Latvia, and your doctor should therefore be familiar with the more common chronic illnesses.
Public healthcare in Latvia was heavily impacted by budget cuts after the 2008 downturn. It is not held by the WHO to be of as high a standard as public healthcare in some other European nations. Chronic illnesses tend to be managed at primary care level, with GPs providing many of the necessary services. However, there has not hitherto been an overall, cohesive strategy relating to the management of these diseases.
The Latvian healthcare system recognises, however, that this is required. A number of policy documents have been drawn up in recent years relating to chronic disease management. There is some provision available. For example, the Vaivari National Rehabilitation Centre offers services related to chronic care, including:
- Neuro-rehabilitation programmes
- Education programmes in disease prevention
- Paediatric rehabilitation programme for children with conditions such as chronic lung diseases, myocarditis or rheumatism
- Adult rehabilitation programme that helps patients recover after heart surgery, chronic pulmonological diseases, myocarditis, rheumatism and other diseases
The national healthcare system has begun to set up guidelines to define roles, responsibilities, and how different stakeholders interact at particular care levels. They cover disease prevention, health promotion, primary and secondary care, criteria for specialist consultation, and availability of health services.
Primary care at a GP level is likely to have a central role in chronic disease management. There are also plans for an increase in nursing staff for those GP practices that have a high proportion of patients with chronic disease, as well as training for primary care staff on supporting patient self-management and other services. The development of home healthcare at primary level has also been planned.
The state system covers:
- GP visits, including one annual preventative check-up
- Specialist visits
- Laboratory tests
- Home care
- Emergency medical assistance
- Hospital care
- Reimbursed prescriptions and medical devices
You will need to pay a fee to see a doctor. Some people are exempt, but exemption categories may not include some chronic illnesses. If in doubt, check with your GP’s practice. However, many of the services above will apply to you, as a sufferer from a chronic illness, if you choose to go down the public healthcare route.
For specialised medical care, you will need a referral from a doctor, usually your GP. However, if you suffer from certain diseases, you will not need a referral to see any of the following:
- Pneumonologist (lung doctor specialising in tuberculosis)
- Chemotherapy specialist
The patient’s fee cannot be refunded in Latvia, but you can claim reimbursement when you get home.
Applying for disability/sickness benefit
To claim invalidity benefit (invaliditātes pensija), you must obtain a State Medical Commission for the Assessment of Health Condition and Working Ability (SMCAHCWA) ruling. You must also have made social security contributions for at least three years. You will receive €60 to €102 per month, depending on the severity of your disability/illness.
Private cover for chronic illness
Note that the country is becoming a destination for medical tourism. If you choose to access the private sector, you will find a wide range of treatments available, in a health tourism cluster consisting of state, municipal and regional hospitals, private clinics, medical rehabilitation centres and resort hotels. Private medical tour organisations can arrange individually tailored rehabilitation programmes for you. Riga has at least one breathing clinic, which may be of help if you are asthmatic. It also has a specialist endocrinology and diabetes clinic, which can assist if you suffer from diabetes.
Health insurance from local providers in Latvia is said to be cheap: around €60 per year. However, you may find that these policies are limited and that they do not cover you for all contingencies. Therefore, many expats opt for health insurance from the main international providers, especially if they have a chronic condition.
The lovely country of Latvia offers many opportunities for sporting activities. For example, you can take part in water sports, such as surfing and parasailing, along the country’s beautiful coastline. Alternatively, you could visit the mountainous regions, which have some excellent ski resorts.
If you are living in Latvia, or simply visiting, there are many opportunities to take advantage of. However, you will also need to make sure that you are covered for sports-related injuries. We will look at some of your options below.
What cover is available for residents of Latvia?
Latvia has a national health service, which operates on a co-pay scheme. If you are a permanent resident in Latvia, you will be entitled to access state-funded healthcare under the same conditions as Latvian nationals. If you come from the UK, you may be entitled to state healthcare paid for by the UK government.
As an expat from the EU/EEA, you will be able to use your EHIC. However, you may also want to take out private insurance, as this will cover you more comprehensively for non-acute situations. You will need to make sure that your current insurance covers you for sports injuries.
What cover is available for visitors to Latvia?
If you are visiting Latvia, you need to make sure that you have comprehensive travel or health insurance that will cover you in the event of a sporting injury. You may need to tailor this to your particular requirements, depending on the nature of the sports that you are planning to do. You may also wish to consider a policy that has a medical evacuation clause.
If you do sustain an injury, you will need to contact your health insurance provider to check that treatment will be covered under the terms of your policy. If so, your provider may be able to pay for your healthcare treatment directly. However, you’ll need to discuss this with the hospital, as they may ask you to pay in cash and then claim the money back from your insurance company once you have returned to your home nation.
Note that most insurers set out time limits for compensation claims. You will not be able to retroactively claim compensation for an injury suffered many years ago, for example.
If you have booked your holiday through a registered travel agent, you should be covered by existing legislation. They will be able to advise you with regard to making a claim.
Check that your existing health insurance policy covers you for repatriation, as many policies do not. Also, check that your policy has a clause that is dedicated to covering sports injuries. This can be either as additional cover or as specialist cover, such as water sports insurance.
If you do opt for specialist cover, make sure that this includes the activities that you are actually planning to do. Most companies will cover sporting activities to some extent, but the levels of protection can vary. Travel insurance policies may cover snorkelling and diving, for example, but not sea kayaking. Most will cover:
- Stand-up paddle boarding
- Water skiing
Check, too, that your specialised policy does not have personal liability clauses that exclude vehicles such as jet skis. For example, most travel insurance policies either do not include the following, or they have exemption clauses:
- Jet skiing – you must follow local rules relating to water safety
- Scuba diving – many policies will only cover you if you have an open water licence, are diving under the supervision of a licensed instructor, and do not dive below a specific depth limit (usually 130 feet, but this is unlikely to apply to your diving experience in Latvia, which will be mainly in the Gulf of Rīga)
- Sailing – you must stay within 10 to 12 nautical miles of the shore
- Yachting – you must be within 60 miles of a safe haven
- White water rafting – some providers will only cover grade one to three rapids, while others may cover up to grade five
- Fishing – some insurance providers won’t cover deep sea fishing or spear fishing
- Paragliding – usually only tandem paragliding with a licensed instructor is covered
In addition to watersports, Latvia offers extensive skiing opportunities, with a number of resorts, such as Gaizinkalns and Siguldas Pilsētas. So, make sure that your medical insurance covers you for any injuries on the slopes. You should be looking at a minimum of £3m in medical cover. Ensure that your policy includes travel back to your home nation if required, plus mountainside rescue. You will also need details of a 24-hour emergency helpline.
Make sure that your policy contains a personal liability clause. This will cover you against legal action if you injure another person. We recommend that you get cover of at least €1m.
A loss of use clause will cover you for any period when you cannot use your ski pass due to bad weather, illness or injury. This generally takes the form of a monetary amount per day lost, so if you injure yourself, factor this into your insurance claim.
If you are planning on engaging in any ‘extreme’ winter sports, such as heli-skiing, check whether your policy will cover this.
Finally, make sure that your private insurance includes reference to any pre-existing conditions.
See below for some average costs for a week’s winter sports coverage:
- Individual in their mid 20s: £8 to £79
- Couple in their early 30s: £13 to £133
- Family of four (children aged eight and 12): £19 to £239
- Couple in their early 60s: £24 to £140
Specialist policies can allow you to ski off-piste. Ski Club, for example, offers a policy for £130 annually for a 35- to 69-year-old for up to 45 days’ skiing a year. Alternatively, they offer £210 annually for a couple and their children.
Where to seek treatment in Latvia
Where you seek treatment will depend on whether you wish to access the public or the private sector. Either way, you should experience no problems in finding a suitable clinic. The ORTO clinic in Rīga, for example, offers treatments in sports medicine. It is partnered with the Latvian Olympic Committee and most of Latvia’s leading sports clubs, and it treats many top Latvian athletes.
Latvian healthcare operates on a two-tier system, with both a private and a public sector. Some prescription medication is available, on a reimbursement basis, if you are covered by the Latvian national health insurance scheme. You should not find it too difficult to access the medication that you need, but we will look at some of your options below.
What is available
It is advisable to take your prescription medication into Latvia with you. You can usually take up to a three-month supply of medicine. Make sure that you keep it in its original packaging, as this will save you from problems at customs. It will also make it easier to identify your medication, or else a generic alternative, at your local pharmacy.
For some prescription medication, such as medicine that falls under the Opium Act, you may need a medical certificate from your GP. You can check whether you will need this with your GP or with the Latvian diplomatic mission in your country. If you do, then take it into the country with you along with your medication.
In Latvia, medication is quite strictly regulated. Latvian stakeholders in the pharmaceutical sector include the Ministry of Health, the State Agency of Medicines, and the national health service (NHS) itself, which is responsible for pharmaceutical regulation and reimbursement. Reference pricing is followed and prices are revised four times a year.
The positive reimbursement list for outpatient care consists of three parts:
- 100%: chronic, life-threatening disease or a disease that results in a severe, irreversible disability, such as rheumatoid arthritis
- 75%: chronic disease, such as IBS
- 50%: other chronic or acute disease
Outpatient medication is thus classified into one of three reimbursement categories, and the patient pays the remainder of the cost. Medication during inpatient care is included in the cost of inpatient services (inpatient drugs are purchased by health service providers) and are provided for free.
The NHS evaluates an application for a particular medication to be put onto the list using several criteria:
- Burden of disease
- Therapeutic value of a pharmaceutical
- Correspondence to treatment schemes
- Cost-effectiveness of the product
- Impact on the healthcare budget
In some cases, the NHS may approve the reimbursement of individual medicines that are not included on the positive list at present and when alternative treatment is not available. GPs need to request this for individual patients, and a council of specialists make the decision, depending on whether the medication is necessary for saving the life of the patient.
50% reimbursement applies for all nationally registered prescription medicines for children up to 24 months. 25% reimbursement applies for all pregnant women and women who have given birth within 42 days.
If you are registered with the Latvian public healthcare scheme, you will thus be entitled to some prescription medication on a reimbursement basis. If you are not sure whether this applies to your medication, consult your GP or your local pharmacist.
How much do prescriptions cost?
A recent report indicates that Latvian patients experience high out-of-pocket pharmaceutical spending. This is partly because they do not choose generic medicines. It suggests that patient preferences may be an obstacle in implementing policies relating to generic medication. Only about 21% of the population were prepared to choose generic medications. 88.7% of patients said that their doctor’s opinion was the main factor determining whether they chose generic or brand-name medicines.
If patients perceive information provided by GPs, specialists, pharmacists, family members, friends and the internet as positive, they are more likely to choose generic medicines. However, patients reported that good outcomes from brand-name meds made them reluctant to switch to generic medication.
Having noted this, the penetration rate of generic medicines in Latvia is reasonably high. As an expat, you should find that your brand-name medication can be replaced by generics relatively easily. Some sample over-the-counter costs are as follows:
- Ibumetin, a painkiller, will cost you around €1.89 for a packet of 10 pills
- Cough syrup will cost you around €8
- Paracetamol syrup for children will cost you in the region of €3 to €4
- Omeprazole will cost you around €3.45 for a packet of 20 pills
- Aspirin will cost you around €3 to €4 for 20 pills
Latvians tend to complain that they pay high over-the-counter costs, but analysis suggests that, whilst some drugs are more expensive, others are cheaper than elsewhere in Europe.
How to get the care you need
Your first port of call for your prescription medication in Latvia should be your GP. Once you have registered with a local practice, you can access your local pharmacy for prescription meds.
You can only obtain non-prescription medication online in Latvia. However, you should have little difficulty in finding a local pharmacy. For example, you may find a Mēness Aptieka (a popular chain), particularly if you live in a large urban centre, such as Riga. Some of the newer and larger pharmacies, such as Euroaptieka, may have consultation rooms with pharmacists.
Note that there is a difference between pharmacies, which are the only places where you can access your prescription meds, and outlets such as Drogas, which is one of the Baltic states’ largest cosmetic retailers, selling health and beauty brands.
The Baltic state of Latvia has universal healthcare, funded by government taxation, but it does not rank well in terms of healthcare standards. You may therefore choose to take out private cover, rather than to give birth under the public system. However, maternity care has been improving in recent years.
Generally, the state will cover medical treatment via a co-pay system, but if you are a pregnant woman being treated in connection with your pregnancy, you will not have to pay a fee. We will look at some of your options below.
How to decide on a birth plan
A birth plan is a list of what you would like to have happen during labour and afterwards. It is written so that your doctor knows what your wishes and expectations are.
- Where do you want to give birth?
- Who do you want to have with you (e.g. your partner)?
- What kind of birth do you want (e.g. vaginal birth or a Caesarian)?
- Do you need any birthing aids?
- Do you want pain relief, and if so, what kind?
- What kind of birthing environment would you prefer?
Provision, particularly in the private sector, is comprehensive when it comes to birthing methods, with both vaginal and C-section delivery available, as well as home births and water birthing.
Maternity care in Latvia
In 2018, the infant mortality rate in Latvia was at about 3.3 deaths per 1,000 live births, and it has been steadily declining over the past couple of decades. You can rest safe in the knowledge that Latvia is a comparatively safe place in which to give birth.
Your first stop will be your GP, who can confirm the pregnancy and set you up with a series of appointments relating to blood tests and ultrasounds. Under state health insurance, you are entitled to:
- Consultations with a gynaecologist, midwife or family doctor (who must be registered with the national scheme)
- Determination of body mass index
- Fetal heartbeat monitoring
- Laboratory examinations
- Fetal ultrasound
- Other services according to the national healthcare programme
- Postpartum care for 42 days after labour
This is free, as long as:
- You have an EHIC card
- You are a citizen of an EU nation
- You have residency and are registered with the national scheme
Under the public scheme, you will be directed to a local hospital, such as the Riga Maternity Hospital, which offers both public and private care. It also offers prenatal classes in Latvian, Russian and English. You should be able to find a range of both prenatal and postnatal classes in Latvia.
The rules surrounding home birthing have recently changed. Now, the Ministry of Health has declared that only low-risk expectant mothers will be able to give birth at home in Lithuania. If this is your chosen option, you will still need to submit an application with a medical establishment and sign a contract, under which you will receive consultations before and after the birth, as well as assistance during the birth. You will also need to be visited by an obstetrician after the birth. Additionally, you will need to prove that you have certain facilities for the delivery:
- A clean and warm room
- Hot water
- A hard surface (for resuscitation of the baby, in case of emergency)
- Ambulance access within 30 minutes of the local hospital
If you are under 18, over 40, or are giving birth for the first time, home delivery is not allowed.
You will be able to access a doula in Latvia. The Latvian Alliance of Doulas (Latvijas Dūlu apvienība) was established in 2010 and has a list of members; contact them if you would like the services of a doula.
Most midwives operate in the public system, but there is at least one private midwifery practice in Latvia.
You will be guaranteed 56 days of leave after the birth, as well as 56 days before the birth. This totals 112 days (roughly 3.5 months) of paid maternity leave. Fathers are guaranteed 10 days of paid parental leave after the birth of a child.
Birth certificates are obtained from the registry office. You may request a copy of a certificate by completing an application and presenting a valid identification, either in person or online through the Latvian State Portal.
Will the baby be a Latvian citizen?
A child will be granted Latvian citizenship if one of their parents is a Latvian citizen at the time of their birth.
If you are an expat living and working in the Baltic state of Latvia, you will need to sort out your healthcare once you have arrived in the country. The state works on a two-tier system, with both national healthcare and a private sector.Your entitlement to access public healthcare in Latvia will depend to some extent on your country of origin. For example, if you are British, you will have some options under the public system. If you are a member of an EU state, you will be able to use your European health insurance card (EHIC).
Many expats choose to take out private cover during their stay in Latvia. We will look at some of your options below.
How does the Latvian state health insurance system work?
The Latvian national health service (NHS), known as nacionalais veselibas dienests, was established in 2011. In 2017, the Latvian government passed a law to introduce a new compulsory health insurance system, but this was canned in 2019, on the grounds that it would undermine equity and accessibility. Therefore, Latvians and expats resident in the country are still governed by the old NHS system, if they wish to access public healthcare. This operates on a co-pay scheme, so you may need to pay up front to use parts of the healthcare system.
At the time of writing, if you are a UK national, you can access the Latvian healthcare system by:
• Being employed or self-employed in Latvia and registering as a temporary resident
• Using a UK-issued EHIC for temporary stays
• Registering a UK-issued S1 with the Latvian NHS
The S1 form gives UK nationals access to state healthcare on the same basis as a Latvian citizen. You will be entitled to an S1 if you receive a UK state pension or certain other benefits.
You must register with the NHS if you are going to be living in Latvia for more than three months.
You can only register as a resident if you’re employed, self-employed or able to support yourself financially. To start with, you must register as a temporary resident. You can only apply for permanent residency if you have been a Latvian resident for five years.
If you cannot register as a resident, you are not eligible for Latvian state healthcare and will need to take out private health insurance.
If you will be living in Latvia before the end of 2020, the UK government says that your rights to public healthcare in Latvia will stay the same for as long as you remain legally resident.
To register with a doctor, go to your local GP practice. You will need to take your Latvian ID card, which you will get when you register as a resident, and you will need to show your ID card whenever you visit a doctor.
If you pay in excess of €570 in a year for healthcare, you do not need to pay anything the following year. You should keep all your medical receipts, so that you can apply for an exemption certificate from the Latvian national health service if you reach the limit. Children, pregnant women and people on low incomes do not need to pay.
If you have questions and speak Latvian, the NHS has a free of charge information telephone number: 80001234 (working days are 8:30 a.m. to 5:00 p.m.). You can call for advice on medical coverage and co-payment rates. The NHS website also has a full range of medical co-pay costs, written in English.
Dentists must be registered with the state, and they must also make sure that their accreditation is up-to-date with the Health Inspectorate and the Centre of Dentistry. They can work in either the private or the public sector (in some cases, they work in both). There is a single main national association, the Latvian Dental Association (LDA). The Centre of Dentistry is a state-appointed regulatory body, independent of the LDA.
State-financed dentistry services in state-owned facilities are available in two institutions – the Centre of Dentistry and Stradinš University’s Institute of Stomatology – and are accessible to everyone. The service is provided universally to all, including children, and offers emergency healthcare.
Dental care is free of charge for children up to 18 years old, except orthodontic therapy, for which full payment is required. Basic oral maxillofacial surgery is also free for all patients, although note that patients have to pay an appointment fee.
However, usually adults must pay for dental treatment in public sector clinics. If dental treatment is covered in your home country, you will therefore need to contact your national health insurance provider when you get home to claim a refund. However, you may simply choose to make out-of-pocket payments.
Registering with private healthcare in Latvia
Experts report that Latvia is well placed to be a destination for medical tourism, since it has an excellent reputation as a spa centre, particularly among Russians, and some high standard private medical facilities, which are very competitively priced. Therefore, if you choose to access private healthcare in Latvia, you will find a number of suitable options in the health tourism cluster, which consists of state, municipal and regional hospitals, private clinics, medical rehabilitation centres and resort hotels.
Ask friends or colleagues for recommendations if you are planning on getting elective procedures, such as dental implants, corrective optical surgery or cosmetic treatments, and do not be afraid to ask clinics for accreditation and testimonials. Dental costs are not regulated in the private sector, so ask your chosen clinic how much they charge. You will also need to ask them how they wish to be paid. If you plan to claim through your insurance, you may need to get pre-approval from some providers.
If you are planning to relocate to the Baltic state of Latvia, your mental health will be one of your priorities. Your employer should sign you up with the national healthcare scheme, but some expats choose private cover in order to avoid long waiting times and so that they can access a higher standard of healthcare. Your entitlement to access public healthcare will depend to some extent on your country of origin. For example, if you are a member of an EU state, you will be able to use your EHIC in Latvia. We will look at some of your options below.There is provision under the Latvian national health service (NHS) for mental health care. Generally, you need a referral to see a specialist, but you do not need one to see a psychiatrist or an addiction specialist. However, mental health care in Latvia is not as extensive as it could be.
The World Health Organisation (WHO) estimated that 60% of patients attending a primary care physician have a diagnosis of psycho-emotional disorders, and mental health issues form a significant part of the disease burden in the country. As a former Soviet state, Latvia’s ingrained attitudes towards mental health have tended to be somewhat old fashioned. At best, they have not been patient-centred, and at worst, the mental healthcare system was used as a tool for political repression.
The country’s health authorities are seeking to address this and have devised a plan to improve access to mental health care for 2019-2020. €6.7 million was allocated from the state budget for this proposal in 2019, and it is estimated that the plan will require an additional amount of €20.1 million in 2020.
The plan proposes a number of measures to improve mental healthcare, including:
• Increasing the involvement of GPs in mental healthcare
• Successful cooperation between family GPs and psychiatrists
• Involving psychologists and functional specialists in teams dealing with mental and behavioural disorders to further improve accessibility of services
• Implementing preventive testing for children aged one and a half to five years old for mental disorders, as well as allocating appropriate funding for this
The Ministry of Health is also due to assess options for implementing state-financed care for home patients suffering from mental health issues.
The aim is to reduce the number of unjustified hospitalisation cases and to create observation rooms in hospitals to provide treatment for people suffering from mental disorders and drug addiction. In addition, the Ministry wants to develop and revise the provision of mental health medication, to ensure that patients get the medication that they need.
Latvia has also been working with healthcare organisations within the EU, in addition to the OECD. With the assistance of funding from the EU, a number of policy documents, such as the one above, have been developed to try to improve mental health care provision within the country. A number of small-scale initiatives have also been developed, such as the quality comparison of psychiatric hospitals.
The Psychiatric Inpatient Patient Experience Questionnaire for on-site measurement (PIPEQ-OS) has recently been adapted for use in Latvia. It encourages patients to participate in the mental health care system by giving feedback on their treatment. The OECD reports on the importance of high quality care for mental disorders in inpatient settings, and multiple psychiatric hospitals are being reorganised to improve accessibility and quality.
Thus, Latvia’s provision is starting to come in line with mental health treatment in other OECD nations, but you may still find that there are gaps in the system. Many expats choose to take out private health insurance to cover their time in Latvia, and you may find more effective mental health care within the private sector.
You will find a number of private counselling and psychotherapy practices across Latvia, particularly in Riga. Therapists offer a number of specialisations, including:
• Addiction and substance abuse
• Cognitive therapy
• Behavioural therapy
• Family systemic psychotherapy
• Child psychotherapy
• Organisational psychology
• Body mind therapy
• Sand play therapy
• Career counselling
A number of therapists are English-speaking. Do not be shy of asking for accreditation with professional bodies – there are a number of these relating to psychiatry in Latvia, such as the Latvian Psychiatric Association (LPA) – or for testimonials from clients. Latvia has only recently introduced laws that regulate the practice of psychiatry, however; the Law of Psychologists came into force in 2018. Under this new legislation, psychologists can conduct their professional activity in six areas of professional fields, including clinical and health psychology.
If you have difficulties in accessing mental health care on the ground, be aware that you may also be able to sign up with a therapist – including one in your home country – online. An increasing number of psychotherapists have gone digital and offer counselling sessions over platforms such as Skype.
In addition to accessing mental health services, whether in the public, semi-public or private sector, you can take care to safeguard your own mental health by getting plenty of exercise, eating healthily, and taking care not to drink too much alcohol. If you are working away from family and friends, keep in touch with them, even if only by digital means. Isolation can be a factor in mental health problems. It is also worthwhile reading up on the law with regard to mental health discrimination, in case you encounter any difficulties in your workplace.
If you are living and working in Latvia, you will need to consider your healthcare options. For example, what are the associated costs when it comes to health insurance?If you are making contributions into the Latvian national healthcare scheme, you will be entitled to a range of primary and secondary healthcare services in the public sector. However, the World Health Organisation (WHO) has not deemed Latvian healthcare to be of a very high standard. The public health sector has suffered from budget cuts, caused by the 2008 downturn, and has still not bounced back.
Therefore, many expats opt for private insurance, alongside having national health insurance, to cover them during their time in Latvia. We will look at some of your options below.
Personalising your health insurance cover
If you are a permanent resident in Latvia, you will be eligible for state-funded healthcare under the same conditions as Latvian nationals. Health insurance is applicable to all employees and those self-employed persons who have made mandatory contributions. This will entitle you to a range of primary and secondary healthcare, and this is reasonably extensive. However, as noted above, the quality may not be high, and the system is overstretched and overcrowded.
You can also pay out-of-pocket expenses in both the private and the public sector. Remember, however, that costs can escalate rapidly if you have a chronic condition or need to see a specialist. Most expats resident in Latvia therefore opt for private health insurance.
Check the small print of any private health insurance policy to see whether it covers treatments that you may want to access, such as specialist surgical treatment or more advanced dental care. Latvia is increasingly becoming a destination for medical tourism, including for dental treatment.
You may also want to consider a medical evacuation clause. This could be to cover you for treatment in your home nation, or you may want to seek treatment in one of Latvia’s European neighbours.
Remember to check whether your potential policy covers pre-existing conditions; the definition of a pre-existing condition will vary between insurers. Usually, the term applies to any conditions that present symptoms or for which you’ve been treated in the last five years. This normally includes any conditions you were diagnosed with over five years ago, but some insurers have different time limits on when the diagnosis must have been given.
You may also want to check whether your policy has a ‘hospitalisation’ clause covering you for occasional hospital visits. You may need to discuss this directly with your insurer, in addition to pre-approval. Again, Latvia has provision for medical tourism, and you may want to check out some comparative costs while you are in the country.
Take a good look at your potential policy for any cover relating to healthcare that does not apply to you. Some policies have provision for maternity care, for instance, and if you are not intending to become pregnant, then you may wish to reduce your policy costs by having such options removed.
You may also be able to reduce the cost of your premium through cost sharing. This is where you and your insurer share the costs of any treatment. You will pay up to an agreed limit, and your provider will cover the rest. Different insurers will have different ways of arranging cost sharing.
Co-pay: where you pay a fixed sum for your treatment and your insurer covers the rest. For instance, if the total cost of your treatment is €85, and your co-pay amount is set at €40, then you will pay €40 and your insurer will pay €45.
Co-insurance: where you pay a fixed percentage of the total cost and your insurer covers the rest. For instance, if your co-insurance is set at 20%, you will pay 20% of €85 and your insurer will cover the remaining 80%.
Deductibles: where you pay the entire amount allowed for all services provided until the deductible is met. For instance, if your policy has a €1,000 annual deductible, you would pay €85 for each visit to your GP for 11 visits (€1000/€85 = 11.8), after which your insurance would pay out to the doctor directly.
You may also need to take a look at whether there is an out-of-pocket maximum that you would be expected to pay after your deductible has been met.
Let’s say that your plan above, with a €1000 deductible, also has a co-insurance option of 20% and an out-of-pocket maximum of €1500. You will thus pay €85 for 11 visits to the doctor under your deductible until it is met. You will then pay €17 for each visit as your 20% coinsurance, until you reach the co-insurance ceiling of €500 (€1,500 minus the deductible of €1,000), or about 29 more visits (€500/€17 = 29.4). At that point (40 total visits in a year), you would pay nothing more for the remainder of the plan year.
It’s worth doing the maths, especially if you don’t think that you’ll need to make more than a couple of visits to your GP in any one policy period. For example, if you just want dental check-ups with an occasional filling, it might be worth working out whether one or two out-of-pocket costs might be cheaper than full dental cover.
As so many variables have an effect on the cost of international private medical insurance, it is very difficult to give accurate estimates without knowing the full details of the coverage required. However, as a very rough guide, using a standard profile of a 40-year-old British male with no deductibles, no co-insurance, a middle tier plan/product, all modules included and worldwide coverage excluding the US, a ballpark price of around £4,000/$5,000 might be expected. Were coverage to be expanded to include the US, then the premium could increase to almost double that amount.
As an expat in Latvia, you will be entitled to treatment for cancer under the national healthcare scheme, as long as you are registered with it. Many expats, however, choose to take out private health insurance to cover their time in the country. This article takes a look at oncological care in both Latvia and the UK.
Oncological treatment in the UK
If you are a British resident who is returning home for oncological care, you will qualify for treatment under the NHS. If you are an overseas expat and are living in the UK, you will need to have resident status in order to qualify.
If you are not coming from an EU-member state, and you are planning to remain in the UK for more than six months but not to move there permanently, you may be required to pay a surcharge. This is called the Immigration Health Surcharge (IHS) and is payable when you apply for your visa.
The standard surcharge fee is currently:
• £300 per year per person for students and each of their dependants
• £400 per year per person for everyone else
The full amount will be paid upfront for the duration of your visa.
There are circumstances in which this surcharge is not applicable, such as if you are the dependant of a member of the forces who is not subject to immigration control.
If you are diagnosed with cancer and are eligible for treatment, you will be fast-tracked by the NHS to your local oncology department, and a course of treatment will be outlined for you by the oncology team. This may consist of surgery, radiotherapy or chemotherapy, and possibly immunotherapy, depending on the type of cancer you have.
You will not need to pay out-of-pocket for any treatment that you receive, including if you stay in hospital. Oncological treatment under the NHS involves follow-up care. You will have check-ups with your consultant on a regular basis (e.g. every three months, every six months, and then annually) after your treatment has finished.
Taking out private health insurance will not make much difference to the quality of your cancer treatment in the UK, as private and public patients receive the same levels of medical care. Private insurance will also not necessarily speed up your access to treatment, since the NHS tends to place a high priority on cancer patients. However, private cover will give you more comfortable facilities, such as a private room in a hospital.
Oncological treatment in Latvia
Latvia has universal healthcare, funded by government taxation, but it is not ranked highly in terms of healthcare standards. If you are a citizen of the UK and are living in Latvia, or if you move there permanently before 31 December 2020, you will have life-long healthcare rights in Latvia, provided you remain resident. Note that you may need to apply for an S1 certificate.
Cancer is one of the leading causes of death in Latvia (it was the second most common cause of death in 2014, with five of the ten main causes being due to different forms of the illness), and patient outcomes are not among the best in Europe. In fact, the WHO reports that both screening rates and net survival for breast and cervical cancer are among the lowest in the EU. Lung cancer continues to be the most prevalent form of cancer, which relates to the high rates of nicotine use in Latvia.
Survival after a diagnosis from breast cancer, cervical cancer and colon cancer has increased slightly in Latvia over the past ten years, but it still does not compare well to in some of the country’s European neighbours. The WHO believes that this relatively low survival rate from treatable cancers is partly due to low screening rates, which mean that a higher percentage of cancer patients are diagnosed at a later stage.
The WHO reports that in 2015, for example, only one quarter of Latvian women in the target group (20 to 69 years) were screened for cervical cancer during the previous three years, and only one-third of women in the target group (50 to 69 years) had mammography screening during the previous two years.
The Latvian government has increased its efforts to improve oncological care in the last decade. National cancer control strategies were brought in during 2009. Cancer care delivery has been centralised, and specialised institutions have been overhauled in order to improve the quality and effectiveness of care delivery. A national plan was adopted in 2017, aiming to improve cancer care in Latvia: the ‘Green Corridor’ pathway. This prioritises early diagnosis of cancer and aims to reduce risk factors as well as improve access to treatment, plus rehabilitation and palliative care.
Under the new scheme, GPs must refer patients with suspicious symptoms for examination within 10 working days. If a cancer diagnosis is confirmed, your GP must request an appointment at a specialised cancer centre for a specialist consultation and secondary diagnostic tests within another 10 working days. A first treatment decision must now be taken within one month of the first specialist consultation.
In general, cancer care, from screening to early diagnosis to treatment, has been improving in Latvia in recent years. If, like many expats, you opt for private health insurance, you should find that your waiting times are substantially reduced, and you will have access to some top of the range treatment.
Oncological tourism is an increasing part of medical tourism to Latvia. Prostate cancer is the most common form of the disease treated in the private sector in Latvia, often with cyberknife radiosurgery. Some clinics also specialise in Virotherapy, a melanoma (skin cancer) option that is not said to cause the side effects that patients get from chemo. This is a form of alternative treatment that has been embraced in Latvia but which is regarded as dubious in other countries. Make sure you do your research carefully before signing up.
Overall, if you want to use the public sector, you will find a more effective level of cancer care in the UK than in Latvia. However, private treatment in both countries is of a high standard, and the cost of your treatment will be lower in Latvia. Wherever you are, make sure you check that your insurance policy will fully cover you, if this will be your method of payment.