Lithuania Archives - Expat Focus

How To Keep Your Health Insurance Costs Low In Lithuania

As an expat living and working in Lithuania, you will want to make sure that your healthcare costs are taken care of during your stay in the country. If you are employed, it is likely that you will be covered by the public health insurance scheme, known as the CHIF. However, most expats choose to take out private cover as well, either as top-up or as an alternative policy to avoid any issues with the public healthcare system.

Personalising your health insurance cover

Your employer should register you automatically with the CHIF, but check that this has been done. If you are self-employed, you will need to sign up yourself. Consult the CHIF to find out what you need to do. Your state coverage will also apply to your dependants.

You can also pay expenses out of pocket in 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.

Selectable options

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. Lithuania is increasingly becoming a destination for medical tourism, including dental treatment.

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 have been treated in the last five years. This will normally include any conditions you were diagnosed with over five years ago, but some insurers place 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. As mentioned above, Lithuania has provision for medical tourism. Therefore, you may want to look at comparative costs while you are in the country, such as for laser eye surgery.

Take a good look at any potential policy for any cover relating to healthcare that does not apply to you. For example, some policies have provision for maternity care, and if you are not intending to become pregnant, then you may wish to reduce your policy costs by having such options removed.

Cost sharing

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 you have met your deductible. 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 would therefore pay €85 for 11 visits to the doctor under your deductible until it is met. Following this, you would 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). At that point, you would pay nothing more for the remainder of the plan year.

It is 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 this amount.

How To Keep Fit And Healthy In Lithuania

If you are planning to live and work in Lithuania, or simply to visit the country, then you will find many opportunities to stay fit and well there. For example, you could partake in watersports or join your local gym. Alternatively, you may prefer to cycle or hike, while taking in the country’s beautiful scenery. We will look at some of your options below.

Lithuania’s Baltic coast often goes unexplored by Westerners, but it is worth a visit. For example, you may want to try windsurfing at Nida or hiking over the sand dunes. Some resorts have outdoor workout areas with training equipment that you can use for free.

You can also go windsurfing, although you may not want to emulate the achievement of businessman Arunas Rinkevicius, who, in 2005, became the first man to windsurf across the Baltic Sea!

Kitesailing is popular, so this may appeal if you are someone who enjoys extreme sports. The country has a few kitesurfing schools, such as Kaitavimas, which organise kitesurfing classes in Nida and the towns of Palanga and Juodkrante.

Surfing itself is increasingly popular – most Lithuanian surfers come to the sport from kitesurfing initially. Lithuania has never been a big destination for surfers, since the Baltic tends to have wind swells rather than the big swells, but it is a developing sport. Lithuanian surfers say that the advent of the smartphone has made a difference, by making it easier to keep up with weather conditions.

If you prefer mountains to the coast, then you will find both skiing and hiking opportunities available, too. Lithuania has a number of ski resorts, such as Snow Arena in Druskininkai, which is an artificial (indoor skiing) resort that also offers outdoor provision. Akmenynų and Birštonas are also well-known resorts. Liepkalnis in Vilnius (Žiemos trasa) is the biggest ski resort in the country and also has indoor ski provision. The largest ski resorts have up to two kilometres of slopes. Winters in Lithuania are not as cold as they used to be, but they can still be very cold indeed on occasion. Ice hockey is another popular sport in Lithuania.

The country has 54 walking routes and five pilgrim walks, so if you are interested in hiking, this beautiful country is definitely a destination to consider. The area around the Green Lakes is one option, and the region around Vilnius itself is another.

Locals recommend hiking along the coast from Šventoji to Klaipėda, and/or from Klaipėda to Nida on the Curonian Spit. Camping is not allowed on the Spit, so you will need to find accommodation in one of the local villages. You should familiarise yourself with the regions that do not allow camping before you set out.

Nida to Smiltyne is also recommended as a hike or a cycle ride, and you will find that bicycle rental outlets are widespread. Lithuania offers impressive pine forests and some lovely rivers, which provide great views while you are exercising.

As there are almost 3000 lakes in the country, you may want to try lake swimming. However, make sure that you take basic precautions, especially if you are inexperienced in wild swimming. Lake Plateliai in Samogitia is one option, and the district of Zarasai is another. Lakes in Aukštaitija National Park are also available.

Make sure, if hiking, that you check what the weather will be like. Take some basic precautions if it is hot, such as sunscreen, water and a hat, as well as a waterproof, in case the weather turns bad. If you are heading into the mountains, be aware that the weather in such regions can change quickly. Watch out for mist and fog, for example, as it is easy to lose your way.

You will find a wide range of gyms and fitness centres in the country, particularly in the cities. Some are attached to hotels and have swimming and spa facilities.

If you enjoy playing golf, you may want to book a golfing holiday in Lithuania. The country has its first 18-hole championship course at the Capitals Golf Club, and there are other courses available.

Lithuanians also enjoy basketball, football, athletics and cycling. Professional athletes and trainers are educated at the Lithuanian Academy of Physical Education, and Lithuanians regularly participate in both the Winter and Summer Olympics. The country has regularly won basketball championships for many years, and the sport is often jokingly described as the country’s ‘second religion.’ Football is popular, with Žalgiris Vilnius being the country’s premier club, but the country still lacks infrastructure, such as stadiums. Rugby has been played in the country since the 1960s.

You will find a number of spas and wellness centres in the country, which offer a variety of massages. You may want to try traditional mud therapies, for example. The country also has a high number of mineral springs. If you are interested in herbal medicine, then you are in luck, as Lithuania has a long history of phytotherapy (Western Herbal Medicine).

In addition to exercise and relaxation, you may want to consider your diet while you are in Lithuania. The country is not necessarily known for having a healthy cuisine, with fried food, potato dumplings and potato pancakes all being regular features on the menu (although they are delicious!). However, you will find some vegetarian and vegan options, including the aforementioned dumplings and ‘blinis.’

Lithuania does have a problem with alcoholism, and you may experience a hard drinking culture, so be careful about your alcohol intake.

Overall, if you watch your diet and make the most of your opportunities for exercise in Lithuania, you should have little trouble in remaining fit and well.

Dental And Ophthalmic Care In Lithuania: How To Find The Right Options For You

As an expat living in Lithuania, you will need, at some point, to access dental and/or optical care, whether for standard check-ups or for emergency treatment. It is therefore a good idea to look at your options when it comes to dental and ophthalmic care before you move to the country. This article will take you through what you need to know.

How to register with a dentist

There are many private dental practices in Lithuania, and the country is growing in popularity as a destination for dental tourism. If you are looking to register with a dentist, it may be worth asking for recommendations from friends or colleagues.

When deciding which dental clinic is best for you, it is worth thinking about your specific requirements. For example, do you just want to have basic check-ups, or are you planning to take advantage of lower dental costs to have more sophisticated cosmetic dental treatment, such as implants?

To what extent does national insurance cover dentistry?

Dental treatment is not covered by national health insurance, with the exception of dental prostheses for the following groups:

People of retirement age
Children up to 18 years old
People recognised as disabled or partially disabled

You will, therefore, need to take out a private dental plan or pay out of pocket. You will find that costs in Lithuania are significantly lower than elsewhere in Western Europe or the USA.

Accessing private dental treatment

Treatments available in the private sector include:

Surgical and implant treatments
Dental replacements (prosthesis, crowns, bridges)
Zirconium crowns
Porcelain veneers
Dental fillings
Oral hygiene and teeth whitening
X-ray

Some sample costs include:

Consultation: €15
Anaesthesia: €10
Dental X-ray: €8
Panoramic X-ray: €30
Composite filling: €50 to €70, depending on size of filling
Titanium tooth implant: €580
Metal ceramic crowns: €220
Temporary crown: €40
Complete single jaw denture: €360
Dental treatment for children: €20 to €60

If you have private insurance, remember to check with your chosen clinic to see whether they will accept your insurance, and you may also wish to check with your insurance provider to see whether you need pre-approval for any procedures, such as cosmetic dental surgery.

How to register with an optometrist in Lithuania

You will find a range of private opticians, including chains such as Vision Express, in Lithuania. Provision is better in the larger cities, such as Vilnius. You may wish to ask local friends or colleagues for their recommendations.

Lithuania has a growing market share in optical tourism. There are a number of private clinics in which you can sign up for corrective eye surgery.

To what extent does national insurance cover optical care?

Optical care is not covered under the national compulsory health insurance fund (CHIF), unless you have an accident to your eye, in which case you will receive free emergency treatment. Otherwise, you must seek treatment in the private sector for eye care.

Accessing private eye treatment

Costs in the private medical sector in Lithuania are substantially lower than in many European countries, and private sector healthcare has a good reputation in the country. LASIK surgery usually costs from €775 to €1580, but it can be cheaper. Do not be afraid to ask for references and testimonials. Your sight is extremely important and should not be risked on the basis of cost.

Opticians will be private, and you should be able to access eye tests and spectacles/contact lenses with a high degree of professionalism. You should also find that the associated costs are reasonable.

How Does Cancer Care In Lithuania Compare With The UK?

If you are living in Lithuania and are unfortunate enough to be diagnosed with cancer, you may be wondering how oncological treatment in your host country compares with that in the UK. Both nations have a national healthcare system, national health insurance, and well-developed private sectors. We will look at some of your options below.

Oncological treatment in Lithuania

Cancer is a leading form of death in Lithuania, with lung, breast, colorectal and prostate cancer being the most commonly diagnosed. The high rate of smoking in the country entails that lung cancer is an issue; it is a primary cause of mortality in Lithuania and the third leading cause of death, particularly among Lithuanian men. It is still below the EU average, but this is only because so few women contract the illness. For men, lung cancer rates are higher than elsewhere in the EU.

In 2017, the World Health Organisation (WHO) reported that both early detection and treatment of cancer have improved in Lithuania, but they are still lagging behind most EU countries.

CONCORD Programme data reports that the five-year survival rate for several treatable cancers increased substantially in the country between 2000–2004 and 2010–2014. This included the rates for cervical cancer (from 53.8% to 57.2%), breast cancer (from 64.6% to 73.5%) and colon cancer (from 44.5% to 56.9%). Nonetheless, these survival rates still remain lower than in most EU countries.

The WHO also says that cancer screening rates have been incentivised by the primary care performance payment system, and they have therefore improved. However, the organisation notes that the uptake is still below the EU average, in part because of the lack of a systematic invitation scheme for screening. In 2015, the percentage of women aged 20 to 69 who had been screened for cervical cancer in the past three years was 47.7%, and this is a lower rate than in most other EU countries.

Mammography screening over the past two years, among women aged 50–69, has improved. It rose from 12.4% in 2006 to 44.8% in 2015, but this, too, remains lower than in most EU countries. The WHO advises that effective screening programmes for these cancers can aid detection at an early stage and potentially reduce mortality rates.

Since 2013, over a hundred new diagnostic and treatment protocols have been in Lithuanian hospitals, which focus on 20 types of cancer, among other illnesses. These protocols are currently being piloted in selected hospitals. There is, for example, a focus on concentrating oncological research and treatment in large hospitals and research centres, thus giving patients access to highly qualified specialists and state-of-the-art equipment. For instance, a new centre for positron emission tomography was built at the Vilnius University Hospital Santaros Klinikos in 2018, and Lithuania is pioneering some cutting edge cancer treatment.

Lithuania has a National Cancer Institute, and the rates of the illness in the country are a concern that the health authorities are attempting to address. However, you may find that there are treatment gaps in the public sector, and you may therefore wish to rely on private treatment when you are in the country, assuming that there is provision for your particular type of cancer. Ensuring that your health insurance has a medical evacuation clause may prove a sensible precaution.

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.

Overall, cancer treatment in Lithuania and the UK are comparable in terms of actual medical care, particularly in the private sector. However, the UK has the edge when it comes to diagnosis, time taken for treatment, and survival rates. On balance, you are likely to fare better as an oncological patient in Britain.

How Much Do Health Procedures Cost In Lithuania?

How much you will pay for health procedures in Lithuania will depend on whether you access the public or the private healthcare sector. The public sector, if you are entitled to use it, is free at the point of delivery, with a few exceptions. However, you will obviously have to pay to use the private sector, either out of pocket or via your insurance. In practice, most expats resident in Lithuania tend to opt for private coverage, partly to avoid any issues in the public system, such as lengthy waiting times. We will look at some of your options below.

State health insurance costs in Lithuania

The WHO reports that health expenditure per capita in Lithuania (€1,406) is currently around half the EU average (€2,797). As a share of GDP, health spending has increased from 5.6% in 2005 to 6.5% in 2015, but it is still the sixth lowest in the EU.

Public healthcare in Lithuania is run by the Ministry of Health, which also runs a number of medical institutions, including teaching hospitals. The national insurance scheme, the CHIF, runs health insurance in Lithuania and operates on a principle of universal coverage. There are five territorial health insurance funds, covering Vilnius, Kaunas, Klaipėda, Šiauliai and Panevėžys.

Public healthcare is funded by mandatory health insurance contributions and the state. Your national health insurance contributions will be deducted from your salary and are currently set at 6.98% of your income. Around 55% of the population are funded by the state, including children under 18, old-age pensioners, and those who are disabled or unemployed.

If you are an EU national and are residing in Lithuania, you will be entitled to treatment under the national healthcare system, as a result of reciprocal healthcare agreements with your home nation. You will be able to use your EHIC. Card holders can apply for medical care directly from a GP that has an agreement with the Territorial Health Insurance Fund (THIF) or Teritorinė ligonių kasa.

If you are an expat from another country and are resident in Lithuania, and you are paying national insurance contributions into the CHIF, you will also be eligible for public healthcare. This will be free at the point of delivery, with the exception of some prescription charges. These have historically been quite high, thus limiting patient access to medication, and the government has attempted to address this recently.

You will be able to access healthcare services provided in private, public, and municipal healthcare institutions if you are not insured under the national scheme, but you will have to pay. Costs can quickly escalate, so it is advisable to have some form of insurance.

The World Health Organisation (WHO) reports that the public health system in Lithuania is heavily reliant on out-of-pocket payments. In 2015, they relate, out-of-pocket payments accounted for 32% of total spending on health. This is well above the European Union average of 22% and is partly due to a fall in public spending on health in the years following the economic crash of 2008.

As we note above, entitlement to CHIF benefits is linked to payment of contributions rather than to residence, but this leaves around 6% to 10% of the population without coverage for non-emergency care. Those who fall under the CHIF benefit from free access to doctors and hospitals, but there are significant gaps in coverage for outpatient medicines and dental care.

The WHO notes that voluntary health insurance does not cover these gaps among Lithuanians, as it is purchased by less than 1% of the population – mainly higher-paid employees. Expats are in a somewhat different position, as a much higher percentage can afford private cover.

How much does treatment cost in the private sector?

Dental treatment is not covered by national health insurance, and you will therefore need to take out a private dental plan or pay out of pocket. Costs, however, are significantly lower than elsewhere in Western Europe or the USA.

Some sample costs include:

Consultation: €15
Anaesthesia: €10
Dental X-ray: €8
Panoramic X-ray: €30
Composite filling: €50 to €70, depending on size of filling
Titanium tooth implant: €580
Metal ceramic crowns: €220
Temporary crown: €40
Complete single jaw denture: €360
Dental treatment for children: €20 to €60

The private sector also offers a wide range of cosmetic procedures. Due to competitive pricing and a high standard of treatment in the private healthcare sector, Lithuania is becoming a destination for medical tourism. Procedures on offer include:

Breast augmentation: €2630
Breast reduction: €1902
Breast uplift: €1902
Tummy tuck: €1902
Buttock implants: €3021
Arm lift: €1902
Thigh lift: €1902
Liposuction: €1231
Facelift: €3525
Brow lift: €1902
Eye bag removal: €615
Botox (one area): €100
Botox (two areas): €201
Botox (three areas): €302

You may need to check with your insurer whether you need pre-approval for cosmetic surgical procedures under your existing policy. You will also need to ask your selected clinic what their preferred method of payment is and whether they will accept your insurance. Do not be afraid to ask about qualifications, references and testimonials, and word of mouth recommendations are often helpful.

What Quality Of Healthcare Can You Expect In Lithuania?

Lithuania has a two-tier healthcare system, comprising a public and a private sector. Its health insurance system is also two-tier, with public coverage and private providers.

The public system is organised by the Compulsory Health Insurance Fund (CHIF), also known as valstybinė ligonių kasa, which was set up in 1993. As an expat, you will be entitled to access the public healthcare system if you are a permanent resident, or if you are a temporary resident and are working in the country.

Overall, both private and public healthcare in Lithuania are held to be of a good quality.

Public healthcare in Lithuania

Public healthcare is run by the Ministry of Health, which also runs a number of medical institutions, including teaching hospitals. The CHIF runs health insurance in Lithuania and operates on a principle of universal coverage. It is funded by mandatory health insurance contributions, deducted from your salary, and the state.

There are five Territorial Health Insurance Funds, covering Vilnius, Kaunas, Klaipėda, Šiauliai and Panevėžys. Municipalities are responsible for organising the provision of primary and social care, in addition to some public health activities. They own some primary care centres, polyclinics and small- to medium-sized hospitals.

The Ministry of Health regulates the healthcare system by:

Formulating health policy
Setting standards and requirements
Licensing providers and health professionals
Approving capital investments

Around 55% of the population are funded by the state, including children under 18, old-age pensioners, and those who are disabled or unemployed. The quality of some public hospitals, particularly outside the cities of Vilnius and Kaunas, is reportedly not as high as in some other Western nations. However, infant mortality is low, even compared to in other European countries, and the ratio of doctors to patients is high.

In saying this, doctors are not evenly distributed between urban and rural areas. Also, waiting times for operations can be lengthy, and there are allegations concerning corruption. Some people report that queue-jumping can occur if you offer a doctor a bribe, for example. This is a legacy of the old Soviet system, in which corruption was, unfortunately, rife.

The WHO reports that there is a general oversupply of hospitals and hospital beds, with the number of curative care beds being the second highest in the EU. This is despite a long-term effort to shift services away from inpatient settings. Reforms have included:

Expanding ambulatory services, including primary care and family medicine
The introduction of gate-keeping
Creating alternative treatment settings, such as day care and day surgery
Strengthening nursing, long-term and palliative care services
Reducing over-reliance on the inpatient sector
Optimising hospitals and specialist services

Extensive renovation of facilities has also been undertaken in recent years. Overall, despite some significant challenges, the Lithuanian public healthcare system has been improving since the early years of the 21st century, even if not as swiftly as originally planned.

The WHO, in its country report on Lithuania in 2017, states that, although life expectancy in Lithuania is increasing (74.6 years in 2015), it is still six years below the EU average (80.6 years). In 2017, it was the lowest in the EU. Furthermore, the gap between the life expectancies of men and women is large. Lithuanian men are expected to live for 69.2 years, which is more than 10 years lower than the 79.7 years expected for women. This is the largest gender gap in the EU.

Health expenditure per capita in Lithuania is half the EU average – €1,400 compared to €2,800. Health spending as a share of GDP increased from 5.6% in 2005 to 6.5% in 2015, but this is still the sixth lowest in the EU. 32% of health spending is paid out-of-pocket, compared to the 15% EU average, largely due to pharmaceutical expenditure.

The WHO also reports that Lithuanian hospital mortality rates are considerably higher than EU averages, but that the country has recently implemented reforms to raise the quality of hospital care. Lithuania has also expanded the role of primary care and, as mentioned above, moved more hospital services to outpatient provision. One of the main remaining challenges is to contain high pharmaceutical spending. Affordability remains a challenge, due to high out-of-pocket payments for pharmaceutical drugs, especially for older and poor people.

Cardiovascular diseases are the leading causes of death among women and men, mainly heart disease and strokes. Cancer is the second largest cause, with 8,000 deaths, accounting for 17% of deaths among women and 23% of deaths among men. Lung cancer is particularly prevalent, although rates of smoking have been dropping across the country. External causes, such as road accidents (particularly among men), and diseases of the digestive system are the next biggest contributors to mortality rates. Alcohol consumption is high, as is the suicide rate. TB is also still a problem in the country.

The state health insurance system is largely free at the point of delivery, and it covers a range of care, including:

Primary care, such as visits to your GP
Preventative health checks
Emergency treatment
Hospital care (you may need to pay for some tests)
Specialists
Maternity care

There are four rates of coverage for prescribed medication, including 100% for life-saving drugs, such as oncology products, and 80% for medication for chronic diseases. Some other drugs are covered at 50% and 90%.

Private healthcare in Lithuania

Lithuania has a good reputation for all kinds of healthcare, especially cardiology and dental treatment, and this is reflected in its growing role as a destination for medical tourism. The private medical sector offers a high quality of care, combined with competitive prices – these can be as low as 25% of the costs in other countries. Dental implants, for instance, can cost in the region of €750, as opposed to almost €3K, which is how much they can cost in the UK.

Private health insurance can cover a range of primary and hospital care, in addition to elective cosmetic surgery, laser eye treatment and dental treatment. You may also want to consider a policy that includes medical evacuation. There is very limited private provision in Lithuania for inpatient care.

What Options Are Available For Chronically Ill Expats In Lithuania?

If you are living and working in the Baltic state of Lithuania and suffer from a chronic health condition, what choices do you have when it comes to healthcare? How effective is the Lithuanian healthcare system when it comes to managing such diseases? We will look at some of your options below.

How does the Lithuanian healthcare system work?

You will be entitled to register with public healthcare (Health Insurance Fund/CHIF) if you are a citizen of the Republic of Lithuania or a foreign national permanently residing there.

If you are an EU national with a chronic condition and are resident in Lithuania, you will be entitled to treatment under the national healthcare system. This is as a result of reciprocal healthcare agreements with your home nation. You will also be able to use your European Health Insurance Card (EHIC). If you are a card holder, you can apply for medical care directly with your GP, as long as the practice has an agreement with the local teritorinė ligonių kasa (Territorial Health Insurance Fund/THIF).

You will be able to access healthcare services provided in private, public and municipal healthcare institutions if you are not insured under the national scheme, but you will have to pay out of pocket.

The Lithuanian healthcare system and chronic illnesses

According to the WHO, the Lithuanian population suffers from a high burden of disease, including cardiovascular diseases, lung cancer, musculoskeletal problems (including lower back and neck pain), and mental health issues. Heart diseases and strokes are the leading causes of death in the country.

According to the European Health Interview Survey (EHIS), nearly three in ten people live with hypertension in Lithuania.

Chronic illness in the country is a prioritised area of healthcare, and some provision is made for patients with chronic diseases.

The WHO reports that efforts to strengthen the role of primary care, particularly in disease prevention, have been underway for over a decade. There have been incentivised services and expanding programmes for prevention and treatment of major chronic diseases. Specialist nursing positions in diabetes and cardiac care for chronic patient groups have also been introduced.

In the 2000s, the government set up a chronic non-communicable disease (NCD) research programme, targeting cardiovascular diseases, cancer and diabetes. Its goal was to provide insights into the management of morbidity and mortality from chronic diseases.

The Lithuanian Health System Development Dimensions (2011–2020) has set out a strategic direction for health promotion, disease prevention and the reduction of morbidity and mortality. This aims to improve health management and financing, in addition to patient access and quality and safety of care. A further goal is the creation of a financing mechanism for the integration of nursing and social care. This seeks to pilot an integrated primary care model based on case management, and the integration of public health services under the aegis of primary care services.

The WHO says that there are indications that the focus on chronic disease management in primary care has led to a reduction in avoidable hospitalisation rates. Lithuania has seen a fall in rates for congestive heart failure (CHF), asthma, and chronic obstructive pulmonary disease (COPD). Since 2013, over a hundred new diagnostic and treatment protocols have been developed, with a focus on cardiovascular diseases, as well as 20 types of cancers, paediatrics and trauma care. These are currently being piloted in selected hospitals. The organisation reports that hospitalisation rates for chronic diseases have decreased, indicating an improvement in primary care services.

Under the public healthcare scheme, if you suffer from a chronic condition, you will be entitled to treatment at primary and secondary level. You may have to make a small co-payment, but much of your treatment will be free at the point of delivery. You will also be eligible for 80% coverage of any medication for chronic diseases.

If you are engaging with the public healthcare system in Lithuania, therefore, and you have a chronic condition, you will find that there has been a substantial focus on chronic illnesses in recent years. You may, however, find that this is balanced by standards that are not commensurate with healthcare levels elsewhere in Europe. Nonetheless, the country has been making considerable efforts to improve the quality of its healthcare.

Applying for disability/sickness benefits

A disability pension (social insurance) is paid for an assessed loss of working capacity of at least 45%. The required coverage period increases with age: at least two months of social security contributions, if you are younger than 22, and this increases by two months a year from the ages of 23 to 38. It then increases by six months a year from the ages of 39 to 63, until you reach 15 years of contributions.

To be eligible for sickness benefits, you must have made at least three months of contributions in the last 12 months, or at least six months of contributions in the last 24 months. 80% of your average income, during three consecutive calendar months before your incapacity, will be paid from the third to the seventh day of incapacity. Your employer will pay 80% to 100% of your average earnings for the first two days.

Private cover for chronic illnesses

Due to the limitations of public sector healthcare in Lithuania, many expats choose to take out private health insurance, particularly if they have an existing chronic condition. You should check with your insurer to see whether they cover pre-existing conditions, as some providers do not.

Private healthcare is held to be of a good standard in the country. Vilnius, for instance, has two asthma clinics. There has been little specific provision for diabetics under the public system, and you may prefer to seek treatment in the private sector for this condition. If you suffer from hypertension, provision is more extensive. Santaros Klinikos, for example, provides vascular advice.

Prescriptions In Lithuania: What Is Available And How To Ensure You Get The Right Level Of Care

Health authorities generally consider Lithuania to have a good standard of healthcare, particularly in the private sector. The public sector also offers some good quality health provision. The country’s healthcare system still faces some challenges, however, and one of these relates to the high level of out-of-pocket spending on pharmaceuticals. The Lithuanian government has been trying to address this in recent years.

What is available?

You may be asked for proof of health insurance on entering the country. We recommend that you also take a three-month supply of prescription medication into the country with you, in its original packaging. You may need to consult the local Lithuanian consulate, or the immigration authorities, regarding certain kinds of medication, such as painkillers that contain opiates.

If you are an EU citizen, remember to show your European Health Insurance Card (EHIC) and ID when you collect your prescription medication. If you are registered with the national health scheme, remember to take proof of this to your doctor and pharmacist. The Lithuanian health insurance fund (CHIF) will reimburse 50% to 100% of the costs of your medication, as long as it is approved by the Ministry of Health. You may need to pay the full price for some medication, if it does not feature on the approved list. If your medicine is on the approved list, the pharmacy will deduct the reimbursement from the initial cost.

Both GPs and pharmacists must inform patients about the prices and surcharges for any medicines that are listed under the same common name in the price-list of reimbursable medicines. You can find up-to-date information on the prices of reimbursable and non-reimbursable medicines by checking the website of the National Health Insurance Fund (NHIF) under the Ministry of Health (although this is in Lithuanian, so you may need a translator).

If you suffer from a chronic disease, you should initially be prescribed a course of treatment for a maximum of one month. If your medication proves to be effective, it can then be prescribed for up to three months. However, this rule does not apply for narcotic and psychotropic medicines, which must be prescribed for shorter periods.

If you do not have your passport for reimbursable medicines, these can still be prescribed on prescription form No. 3 for not longer than a seven-day period.

How much do prescriptions cost?

Paying for pharmaceuticals explains the high levels of out-of-pocket spending by patients in Lithuania, and there has been some recent contention in the local press regarding the cost of drugs.

The NHIF provides coverage for a number of benefits, and this may include reimbursement for medication. Out-of-pocket spending on medication forms the largest share of out-of-pocket payments overall. Patients may find themselves bearing the full costs of both prescribed and over-the-counter outpatient medicine, unless they belong to a group that is eligible for full or partial reimbursement. For instance, children, the elderly, and those who are registered as disabled, as well as patients with diseases such as tuberculosis, cancer and some chronic diseases, are eligible for reimbursement.

Even when the Compulsory Health Insurance Fund (CHIF) offers 100% reimbursement for medication, most patients will incur some form of copayment for outpatient pharmaceuticals, when the market price of the drugs is higher than the reimbursed reference price.

Lithuania has had one of the largest discrepancies between the amount of pharmaceutical costs funded publicly and the amount of overall health services. This is for several reasons:

Copayments for pharmaceuticals are high

There is no effective Health Technology Assessment (HTA) in place
Doctors tend to prescribe unnecessarily expensive brands
There is a low reliance on generic medication

However, a new drug price list was introduced in July 2017, and this should have reduced the cost of user fees by up to a third. Up until this point, many Lithuanian patients bought their drugs over the border in Poland, due to the significantly lower prices there (€1 to €2 for a packet of cold medication, as opposed to €4 to €7).

Nonetheless, in 2018, the WHO reported that out-of-pocket spending on medicines was still a significant cause of financial hardship among Lithuanians. It recommended that policy attention should focus on improving the accessibility and affordability of outpatient prescribed medicines. Reforms introduced to lower medicine prices and encourage appropriate prescribing and dispensing are essential steps in the right direction. However, the WHO believes that further action is needed. Additionally, it asserts that Lithuania’s high use of non-prescribed medicines, especially among people aged over 65, also warrants policy attention.

How to get the care you need

You will be covered by state medical insurance if you are permanently resident in Lithuania. If you are not entitled to public health insurance, you will either need to take out private cover or pay out of pocket costs.

You will need to register with a local doctor. If you are under the CHIF and planning to use public healthcare, check that your local practice is registered with the national health service. Then, find your nearest pharmacy. There are a number of these throughout the country, particularly in the cities. In the 1990s, there were concerns about patients in rural areas being unable to access medication. The health authorities have attempted to address this, by registering primary care providers with pharmacy provision outside the main urban centres.

Lithuania’s Ministry of Health has recently proposed the implementation of a state-run ‘e-sveikata’ (‘e-health’) platform. This is an online gateway to patients’ medical history information, where patients can check the prices of any drugs in different pharmacies. They can order their prescription medication online, plus any medication that is reimbursed by the CHIF.

This plan has been opposed by the Lithuanian Association of Pharmacies, who says that the major chains already run online shops. So far, however, these pharmacy chains only sell non-prescription drugs, due to government regulation. If you think you might find this service helpful, check for updates on its implementation online.

How To Register With The Health System In Lithuania

Lithuania has a two-tier health insurance system, consisting of both public coverage and private providers. The public system is organised by the Compulsory Health Insurance Fund (CHIF), also known as valstybinė ligonių kasa, which was set up in 1993. There is also a growing private sector.

As an expat, you will be entitled to register with the public healthcare system if you are a permanent resident, or if you are a temporary resident and working in the country. Many expats opt for private cover as well, either as a top-up or to bypass the issues in the public sector. We will look at your options below.

How does the Lithuanian state health insurance system work?

Around 55% of the Lithuanian population are state-funded, including children under 18, old-age pensioners, disabled people, and those who are unemployed. The CHIF operates on a principle of universal coverage. It is funded from mandatory health insurance contributions, which are deducted from salaries and from the state itself.

As an expat, you will be entitled to register with public healthcare if you are:

A citizen of the Republic of Lithuania or a foreign national permanently residing there
A foreign national temporarily residing in Lithuania, provided that you are legally employed, and minor members of your family
An unaccompanied foreign minor
A foreign national who has been granted subsidiary protection in Lithuania
A person to whom the Law on Health Insurance must apply under EU regulations on the coordination of social security systems

Most expats will come under the first category.

If you are an EU national and are resident in Lithuania, you will be entitled to treatment under the national healthcare system, as a result of reciprocal healthcare agreements with your home nation. You will be able to use your European Health Insurance Card (EHIC). Card holders can apply for medical care directly with their GP, as long as the practice has an agreement with their Territorial Health Insurance Fund (THIF) or teritorinė ligonių kasa.

You will be able to access healthcare services provided in private, public and municipal healthcare institutions, even if you are not insured under the national scheme, but you will have to pay out of pocket.

Your national health insurance contributions will be deducted from your salary and are currently set at 6.98% of your income.

The same amount is paid by self-employed people, and it is calculated from 90% of taxable income. You will need to make contributions of 6.98% from your minimum monthly salary until the last day of the current month.

If you are self-employed, it is advisable to pay compulsory health insurance contributions in advance.

On 1 January 2020, the minimum month’s gross salary was increased to €607, and the compulsory health insurance contribution was set at €42.37 per month.

If you are an expat and are not considered a permanent resident, you cannot be insured with the CHIF, unless you are employed, or else you have worked in Lithuania for six months and are registered with the Labour Exchange

If you are intending to use the public healthcare scheme, you should register with your GP, but, as above, make sure that the practice is CHIF-registered.

To register with a dentist, you will need to find a private practice, since dental treatment is not covered under the CHIF. Ask colleagues or friends for recommendations, or investigate using the net and the phone directory.

Registering with private healthcare in Lithuania

Lithuania is a destination for medical tourism. The private medical sector offers a high quality of care, combined with competitive prices: up to 25% of the costs in other countries. Many expats thus choose private cover, even if they are registered with the CHIF through their employer.

Private cover will also enable you to avoid some of the issues with public healthcare in the country, such as the lengthy waiting times. You may also opt for a policy that includes a dental plan. Lithuanian dental care is of a high standard, and dental tourism is a growing sector in the country.

Again, ask people you know for recommendations to find a local clinic, and do not be afraid to ask clinics and medics for testimonials. You may need to check with the clinic to see whether they will accept your health insurance, and you may also need to pre-approve any potential elective procedures with your provider.

Maternity Care In Lithuania: What The Options Are And How To Decide On A Birth Plan

Lithuania has a two-tier health insurance system, comprising both public coverage and private providers. The public system is organised by the Compulsory Health Insurance Fund (CHIF) or Valstybinė ligonių kasa, which operates on a principle of universal coverage. It is funded from mandatory health insurance contributions, deducted from your salary, and from the state.

The state health insurance system covers maternity care, but most expats also opt for private cover, and you may prefer to seek your maternity care in the private sector. 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?

You will need to address the possibility of a C-section with your doctor and midwife. The rate of C-sections in Lithuania has increased from 9.49% in 1995 to 24.71% in 2010, but it has recently started to decrease again, following efforts to increase normal vaginal delivery rates. Note that if you give birth in the private sector, you will pay more for a C-section than for a normal delivery, since the process is more complex.

You will also need to discuss whether or not you want an epidural. Most mothers in Lithuania do opt for epidurals. Expats have described facilities in the private sector as ‘state of the art’, and you should not have too much difficulty in obtaining suitable pain management.

You will have a range of options in both the public and the private sector, such as the Baltic American Clinic in Vilnius, which is private, and Antakalnio Poliklinika, which is public. Gynecologists in the private sector often also work in the public sector.

Costs in the private sector have been quoted at around €10K for the delivery, but for a normal, low risk delivery, as well as a couple of days in the hospital, you could be looking at less (around €4500).

Maternity care in Lithuania

You will have six weekly check ups at least with your gynaecologist, and you will be registered for ultrasounds and other tests, such as blood tests. Do not be afraid to ask for a tour of your chosen hospital before the birth, if this is something you would like.

Check that your gynaecologist and midwife have understood your wishes and concerns, as not everyone in Lithuania speaks English. For instance, if you do not want to know the sex of the child beforehand, make sure that your doctor understands this.

You should be able to get a free eye check-up and dental check-up as part of your maternity care. However, you may have difficulty finding prenatal classes in English.

Expat mums report that Lithuanian doctors prefer you to present yourself at the hospital as soon as your contractions start, rather than when you are more deeply into labour. You will usually stay in hospital for around three days, depending on your delivery, but you will need to pay more for a private room. Your partner should be allowed to stay with you overnight, and you should have the benefit of the services of a midwife in the days following the birth, while you are still in hospital, if you would like them.

Maternity benefit (Motinystės išmoka) is paid initially to the mother for the duration of their maternity leave. It will be paid for 70 calendar days prior to the birth of the child up until 56 days after the birth. In the event of birth complications or a multiple birth, an allowance is paid for an extra 14 calendar days. The benefit is equal to 77.58% of earnings.

Note that you can also get a doctor’s sick note if you are having a difficult pregnancy, such as if you suffer from extreme morning sickness, and need to take time off work.

Paternity benefit (Tėvystės išmoka) is paid to the father for 30 calendar days after the birth of the child. You can choose when to receive your benefit, up until the child is three months old. It is equal to 77.58% of earnings.

A further childcare benefit is paid to one of the parents (adoptive parent) or guardians caring for the child. This is calculated in relation to earnings and depends on the time scale.

A lump sum benefit for pregnant women (vienkartinė išmoka nėščiai moteriai) is payable to those who are not eligible for maternity benefit under the Law on Sickness and Maternity Social Insurance.

Entitlement to all of these benefits extends to all those who are insured against maternity under the social security system and who have a record of social security payments for at least 12 of the previous 24 months.

You should find that many medical personnel in the private sector are English-speaking, but do not count on this in the public healthcare system.

Expats report that Lithuania is a friendly, supportive place to bring up children, and, in Vilnius particularly, there are a lot of resources for children, such as child-friendly cafes. Public daycare tends to be Lithuanian-speaking, but one expat reports that there is an English-speaking daycare facility in Vilnius. There are English schools, in addition to some indoor play areas.

Will the baby be a Lithuanian citizen?

Your baby will not be a Lithuanian citizen unless either you or their father is Lithuanian. You will need to notify Lithuanian institutions of the birth, as this has to be included in the registry of the Republic of Lithuania Civil Registry Office. The birth will be included in the registry, whatever the citizenship of the child.