Latvia has a two-tier health insurance system comprised of universal public coverage and private insurance. If you are planning to relocate to the country, your employer should sign you up with the national scheme, but some expats choose private cover in order to avoid long waiting times and to access a higher standard of healthcare. Your entitlement to access public healthcare will depend to some extent on your country of origin. If you are a member of an EU state, you will be able to use your EHIC in Latvia.

Latvia has universal healthcare, funded by government taxation, but it is ranked low in terms of healthcare standards.

The WHO reports that the Latvian NHS was established in 2011, succeeding 20 years of experimentation with social health insurance after Latvia regained its independence.

In 2017, the Latvian government passed a law to introduce a new compulsory health insurance system, with the objective of increasing revenues to pay for healthcare, thus bringing expenditure in this sector up to 4% of Latvia’s GDP. Under this system, entitlement to the full range of benefits would have been linked in to the payment of social health insurance contributions. However, in 2019 the reform was cancelled, on the grounds that it would undermine equity and accessibility.

Latvian residents are thus still governed by the old NHS system. This operates on a co-pay scheme. If you have questions, and speak Latvian, the NHS has a free of charge information telephone number 80001234 (working days 8:30-17:00), which can advise you on medical coverage and co-payment rates.

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. 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 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.

If you are a UK citizen, you will not be allowed to use your EHIC card in Latvia.

Your employer should sign you up with the NHS, but check that this has been done. If you are self employed, you will need to register with the social security system and arrange to make your own contributions.

You must show a valid EHIC and a passport to receive state-funded healthcare, otherwise your healthcare provider may ask you to pay the full cost of treatment.

The state system covers:

• GP visits, including one annual preventative check-up
• specialist visits
• laboratory tests
• home care
• emergency medical assistance
• hospital care
• rehabilitation
• reimbursements for 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
• pregnant, and 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, if you are suffering from certain diseases, you will not need a referral to see any of the following:

• gynaecologist
• ophthalmologist
• surgeon for children
• paediatrician
• psychiatrist
• addiction specialist
• pneumonologist (lung doctor specialising in tuberculosis)
• dermatovenerologist (skin doctor specialising in sexually transmitted diseases)
• endocrinologist
• oncologist
• chemotherapy specialist
• specialist in infectious diseases

The fee cannot be refunded in Latvia, but 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. There is no such fee if you are:

• under 18
• hospitalised because of pregnancy or childbirth
• undergoing dialysis or some other treatments (e.g. for certain infectious diseases, mental illness)

There are additional fees for:

• CT scans (computed tomography)
• MRI scans (magnetic resonance imaging)

In addition to the fee, your healthcare provider may charge a co-payment sum for a surgical procedure carried out in an operating theatre.

These payments cannot be refunded in Latvia, but you can claim reimbursement when you get home. Latvia operates a benefit-in-kind healthcare system, so there is no system of reimbursement. You should only be charged the patient 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 costs €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 your general contribution, the healthcare provider may charge a co-payment from €1.42 of up to €31 (for example for CT scans, magnetic resonance imaging (MRI), electroencephalograms (EEG), electrocardiagrams (EKG), X-rays, for an endoscopy)

You can also claim some of your prescription expenses from the NHS. Make sure you 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 which 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.

If you are a citizen of the UK living in Latvia, or if you move there permanently before 31 December 2020, you will have life-long healthcare rights in Latvia as you do now, provided you remain resident. You may need to apply for an S1 certificate.

If you are an EU/EEA national, you will have full healthcare rights.

If you are a permanent resident of Latvia, wherever your country of origin, you are entitled to the same healthcare as Latvian nationals.

If you are from the EU/EEA, you will be able to use your EHIC, but you may also choose to take out private insurance in order to be covered more comprehensively for non-acute situations.

If you are not from the EU, you will need to have health insurance which should guarantee coverage of expenses, including:

• emergency medical assistance
• inpatient treatment
• transportation to hospital
• medical evacuation to your home nation

The minimum coverage limit indicated in the policy cannot be less than €42,600 over the insurance period for a long-stay visa.

Your family will be covered under the public healthcare scheme if they are resident in Latvia. If you are a temporary resident and live in Latvia in connection with your employment or you are self-employed, your family members will also be entitled to state-funded healthcare services.

State-funded dental care in Latvia is only available for children. Adults must pay for dental treatment, which is not refundable. 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.

The rate of the state social insurance mandatory contributions (SSIMCs), if the employee is insured for all types of social insurance, is 35.09%: 24.09% paid by the employer and 11% paid by the employee. 1% of the total goes towards the financing of health care services.

A hitherto poor level of investment in healthcare, resulting in standards which are still below those of other EU nations, in addition to long waiting times, result in a number of expats opting for private health insurance. Experts point out that Latvia is well placed to be a destination for medical tourism, since it has an excellent reputation as a spa centre, particularly among the Russians, and some high standard private medical facilities which are very competitively priced.

Health insurance will cover a full range of primary and secondary healthcare and also elective procedures such as cosmetic surgery and more advanced dental treatment. If you are an EU citizen, you may also wish to explore the possibility of seeking treatment in Latvia which will be paid for by your home nation, under the EU directive for cross-border care.

Note that the country is becoming a destination for medical tourism, and if you choose to access the private sector, you will find a wide range of treatment available in a health tourism cluster consisting of state, municipal and regional hospitals, private clinics, medical rehabilitation centres and resort hotels.

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 may not cover you for all contingencies, thus many expats opt for health insurance from the main international providers.

As so many variables have an effect on the cost of international private medical insurance it becomes 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.

Healthcare itself in the private sector in Latvia is very competitively priced, with an estimated 50-70% lower costs than in other EU or Scandinavian nations, or the USA. For instance, rhinoplasty procedures will cost in the region of €2400 as opposed to €5900 in the US and €4500 in the UK. A dental implant will cost €650 in Latvia but €2K- 2,500K in the UK and the US.

There are a number of local health insurers, including:

• Balta
• Ban
• BTA
• Seesam

You may however wish to opt for a policy from one of the international providers such as:

• BUPA
• Cigna
• Foyer Global Health
• Pacific Prime

Nacionalais veselibas dienests – the National Health Service (NHS)

The Latvian NHS website is also available in English.