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International cooperation

Oxford University Press is preparing to publish a handbook covering health politics in Europe with chapters on 37 countries, including some non-EU countries. The chapter on the Latvian healthcare system has been written by Edgars Eihmanis (pictured), researcher at the Rīga Stradiņš University (RSU) Institute of Public Health, and doctoral student at the European University Institute in Florence, Italy.


Each country included in the handbook has been covered by a researcher from that respective country. This means that a very broad group of authors have prepared surveys on the development of various healthcare systems over the last 30 years. The survey of the Latvian reforms begins in 1993 when, the country having just regained its independence, the first healthcare reforms were implemented.

Helicopter view

Eihmanis describes applying a kind of helicopter view in his chapter detailing the situation in Latvia. He presents a structural outline of the main trends and their drivers over a longer period, and has consciously avoided evaluating specific reforms where other researchers might have gone into more detail looking at personalities and events. The focus of the book is not the healthcare system itself, but rather the political process – the parties, the institutions, the ideas and the coalitions of players that have given healthcare systems their present shape. The main question that permeates all chapters of the handbook is: ‘Why are healthcare systems all over the world so different?’ To answer the question a number of political and economic factors must be taken into consideration seen from a historical perspective. Even though the operating principles of the Latvian healthcare system, as well as its problems, have been written about a lot, attempts to explaining the political origins of these reforms are much rarer. 

How was the research structured?

Eihmanis has performed an enormous amount of research to write the chapter on Latvia. He selected approximately 50 of the most significant reforms and entered information about them into a special database that will be made accessible to anyone interested in this particular topic. Eihmanis also used his previous research on related subjects. He explains that an important characteristic of Latvian politics is the fact that healthcare has rarely been put forward as a priority in political campaigns in the last decades. Political priorities have mostly focused on matters of national identity and fighting corruption.

The researcher believes that healthcare reforms in Latvia have been influenced and formed by a somewhat distorted view of the free market, the non-interference of the state and individual responsibility for diseases and treatment. A notable example of that is, in his opinion, the radical decentralisation at the beginning of the ‘90s. This included transferring a considerable part of the functions of healthcare administration to local governments, asking for high co-payments from patients and also the idea of dividing patients into two groups, something which is presently much criticised. Due to the social consequences of these reforms they have also been met with a lack of understanding from many international organisations.

Presently the text about Latvia is in the final stages of editing and the handbook will be made available electronically and in print in the autumn. The standardised structure of the handbook’s chapters will make it convenient for researchers to compare reforms in different countries. A researcher from Portugal, for example, will be able to obtain information about Latvia, Hungary and Poland and write a publication evaluating and comparing healthcare financing mechanisms. 

How did the cooperation with RSU begin?

Eihmanis is currently writing his doctoral thesis at the European University Institute on the subject of Eastern European tax system reform over the last fifteen years. There are around 600 doctoral students at the institute who work in four basic areas of research – social sciences, history, economics and legal science.

Apart from his doctoral thesis Eihmanis is engaged in several research projects and has prepared various publications on economic governance, party competition before the financial crisis, the origins of the world's tax regimes and European integration. His current successful cooperation with RSU is based on that research work. Approximately a year ago Eihmanis met with Professor Gunta Lazdāne, the Director of the RSU Institute of Public Health, and the idea of a common publication was born. Eihmanis had been wanting to collaborate with RSU for some time already as it is a leading European higher education institution.

Truth is born through comparison!

Eihmanis believes that comparison with other countries has great potential and could greatly contribute to Latvian research. Focusing on current political processes in one country can lead to losing a broader view of the present situation, the way in which a country got to where it is, and possible further action that needs to be taken. Since we were born and have grown up in Latvia, many things that take place here seem self-evident, even if they are actually not. Latvian ideas about the level of social solidarity required in order to develop the economy illustrates this very clearly. A broader perspective, which encompasses other countries, could help discern that such assumptions are not always justified, and possibly correct them. A comparative perspective in research is also a great way to make our experience interesting for researchers and political professionals outside Latvia.