Dissertation on Health Policy Reform in Latvia from 1990 to 2020

Health policy reform in Latvia was initiated more than 30 years ago to transform the Soviet-era health care system into a new, population-centred, rational, and accessible system of healthcare service providers.

Looking at the results of the reform after 30 years, it can be observed that a number of changes that have been successfully implemented.

At the same time, when comparing the desired results of the reform with the healthcare systems of our neighbouring countries, the reform implemented in Latvia has failed to deliver a population-centred and accessible healthcare system.

Problems with access to health care are evidenced by higher preventable mortality rates, lower life expectancy, and a variety of other problems, like a smaller selection of publicly funded services, longer wait times, and high co-payments.

The goal of Ieva Bikava’s doctoral thesis, doctoral student and lecturer at RSU, was to evaluate the Latvian healthcare reform between 1990 and 2020 from the perspective of historical institutionalism in order to find answers to three research questions:

1. What health policy changes were implemented within the framework of the reform?
2. What reform objectives were achieved in these 30 years?
3. Why was there a delay in achieving the objectives of reforming Latvia’s health policy?

In line with the theoretical approach chosen, the thesis studies the development and implementation of Latvian health policy, analysing the socio-cultural, regulatory, and normative pillars influencing health policy, as well as identifying prevailing values, ideologies, and directions of public administration reforms. According to the approach, three separate time periods were defined: the period of deregulation, regulation, and re-regulation.

Using this analytical approach, the research revealed important factors that affected the implementation of the reform in addition to the well-known issues of inadequate financing of the sector and lack of human resources. These explain why the objectives of the Latvian health policy reform were not met and why Latvia is currently in a worse position than its neighbouring countries.

Ieva Bikava will defend her doctoral thesis “The Reform of Latvian Health Policy From 1990 to 2020 from the Perspective of Historical Institutionalism” on 23 February 2023.
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RSU dissertation database