Laws and regulations on healthcare financing and reimbursement
1. Please provide a bird’s-eye view on the healthcare economy, indicating, in general terms, the role of the government (public healthcare) and private actors (private
healthcare).
The Lithuanian healthcare system is funded through contributions to a compulsory health
insurance (CHI) scheme mainly managed by the National Health Insurance Fund under the
Ministry of Health (NHIF). Funding is derived from mandatory payroll contributions from the
employed population and allocations from the general government budget to cover the non
working population, ensuring universal coverage. These contributions feed the Compulsory
Health Insurance Fund (CHIF), which reimburses a variety of healthcare services, medicinal
products and medical devices. At the same time, Lithuania’s healthcare system relies heavily on
out-of-pocket (OOP) payments. Medicinal products constitute the largest share of OOP
spending, followed by dental care.
The Ministry of Health (MoH) oversees the regulation and policymaking for the health system.
In addition to managing the NHIF, it supervises several subordinate agencies responsible for
medicinal products control, public health functions, and the licensing of services and healthcare
professionals. The MoH also owns or co-owns certain healthcare providers, including all
tertiary hospitals. Primary healthcare centres and most district hospitals are owned by
municipalities, which also handle some public health responsibilities.
The private sector plays a minimal role in inpatient care but has a significant presence in
outpatient care, particularly in dentistry. Many general practitioners operate as private
providers, and the NHIF regularly contracts private providers for primary care and some
specialised outpatient services.
2. Please provide a high-level overview of the legal framework regarding healthcare financing and reimbursement.
Financing and reimbursement are mainly governed by the Law on Health Insurance of the
Republic of Lithuania (LHI). LHI sets the general framework for healthcare financing and
reimbursement from the CHIF budget, such as types of persons insured by CHI, the principles
for forming the CHIF budget, reimbursement of expenses for personal healthcare services,
acquisition and reimbursement of medicinal products and medical devices, as well as
reimbursement of rental costs for medical equipment necessary to ensure home healthcare
(nursing) for insured persons, etc.
LHI also defines the institutions responsible for implementing the CHIF budget, the rights
and obligations of persons insured by CHI and healthcare organisations in the context of CHI, the procedures for dispute resolution, the principles for cross-border healthcare cost
reimbursement, and the basics of supplementary (voluntary) health insurance.
More detailed (specific) rules regarding reimbursement are provided in separate implementing
legal acts, mainly adopted by the MoH. These legal acts are categorised by the health areas such as healthcare services, nursing, medicinal products, orphan medicinal products, medical
devices, high-cost tests and procedures, etc.
The prices for reimbursable healthcare services and products (such as medical devices,
medicinal products, etc) are fixed by the government unilaterally. Therefore, negotiations are
not that relevant in this field. However, in some cases, manufacturers of medicinal products
(based on the established procedure and only to the limited extent) are allowed to negotiate
the reimbursable prices of medicinal products and medical devices.
3. What are the key regulators and supervisory bodies regarding healthcare financing
and reimbursement?
The main supervisory body in the field of healthcare financing and reimbursement in Lithuania
is MoH. MoH is responsible for formulating, organising, coordinating and controlling the
implementation of public policy on healthcare financing and reimbursement. More specific
tasks related with the implementation of the healthcare financing and reimbursement are
attributed to the NHIF, Compulsory Health Insurance Council (CHIC) and five Territorial
Health Insurance Funds (THIFs).
The main role of the NHIF is to implement CHI and manage the CHIF budget in accordance
with the procedures laid down by law and to properly represent the interests of the insured
persons. NHIF is responsible for adopting decisions regarding reimbursement of healthcare
services, medicinal products, and medical devices. NHIF is subordinated to the MoH.
CHIC is a collegiate advisory body based on tripartite representation. CHIC is composed of
public authorities, organisations of policy holders/employers and organisations defending the
interests of the insured. CHIC provides opinion on various questions related with healthcare
financing and reimbursement in Lithuania.
THIFs manage a portion of the CHIF budget allocated by the NHIF. This portion is used to
cover expenses for services provided by healthcare organisations and to reimburse the costs of
medicinal products and medical devices. THIFs are also responsible for the conclusion of
contracts with pharmacies and payment for reimbursable medicinal products and medical
devices dispensed to the insured persons. THIFs operate based on the five districts in Lithuania
(one THIF for each district). THIFs are subordinated to the NHIF.
Courts do not play a major role in shaping healthcare financing and reimbursement policies in
Lithuania. However, occasionally, decisions are made in this area that establish certain rules,
such as those concerning the obligation to conclude clawback agreements or to reimburse
orphan medicinal products.
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