Lovkyte L, Padaiga Z
Kaunas University of Medicine, Kaunas, Lithuania.
Cah Sociol Demogr Med. 2001 Jul-Dec;41(3-4):347-68.
The health system in Lithuania before independence was the same centralized system, the Semashko model that was prevalent throughout the former Soviet Union. The Soviet system focused more on quantity than quality, which resulted in a greater number of physicians per 100,000 than found in Western Europe. As in other Central and Eastern European countries, the health system in Lithuania has undergone substantial change since 1990. A major part of the reform of physician workforce in the former communist countries has been development of primary health care as a centerpiece of the health systems. This move in Lithuania has been hindered to some degree by the shortage of general or family practitioners. The focus on specialists in the old Soviet system led to a severe shortage of physicians in general practice. Only about 10% of physicians were general practitioners (GPs) in 1993 compared to a European Union average of 35%. That percentage had increased to 16% by 1998. Programs have been established to both train new GPs and to retrain specialists to become GPs, although a shortage of teachers and finances are problems facing these programs. Although the physician workforce in Lithuania has undergone substantial reform since 1990, real change has been slow. The physician to population ratio in Lithuania has failed to decline, moving from 387 per 100,000 population in 1991 to 398 in 1997, before dropping to 395 in 1998. The ratio remains substantially higher than current EU averages, reflecting a difficulty in reducing the number of physicians. Here we review what has happened to the physician workforce in Lithuania since independence and evaluate policies implemented. Efforts to reduce the number of physicians are also assessed. The results in Lithuania are compared to those in other CEE countries and to EU averages.
立陶宛独立前的医疗体系是与前苏联普遍采用的塞马什科模式相同的中央集权体系。苏联体系更注重数量而非质量，这导致每10万人中的医生数量比西欧更多。与其他中东欧国家一样，自1990年以来，立陶宛的医疗体系发生了重大变化。前共产主义国家医生队伍改革的一个主要部分是将初级医疗保健发展成为医疗体系的核心。在立陶宛，这一举措在一定程度上受到全科医生或家庭医生短缺的阻碍。旧苏联体系对专科医生的重视导致了全科医疗领域医生的严重短缺。1993年，只有约10%的医生是全科医生，而欧盟的平均比例为35%。到1998年，这一比例已升至16%。已经制定了培训新的全科医生以及将专科医生重新培训为全科医生的计划，尽管师资和资金短缺是这些计划面临的问题。尽管自1990年以来立陶宛的医生队伍经历了重大改革，但实际变化一直很缓慢。立陶宛的医生与人口比例未能下降，从1991年的每10万人口387人升至1997年的398人，然后在1998年降至395人。该比例仍大大高于目前欧盟的平均水平，这反映出在减少医生数量方面存在困难。在此，我们回顾立陶宛独立以来医生队伍的情况，并评估所实施的政策。同时也评估了减少医生数量的努力。将立陶宛的结果与其他中东欧国家以及欧盟平均水平进行了比较。
