Lithuanian CITIZEN‘S knowledge of and confidence in the mandatory health insurance system

Abstract

Summary When Lithuania regained independence, the old integrated model of state-funded health care financing was replaced by the mandatory system of health insurance. The aim of this study was to investigate knowledge of and confidence in the national mandatory health insurance system and to measure significant changes in a one year period among Lithuanian citizens. Methods. The study was based on the survey first conducted in 2009 and repeated in 2010. Both surveys included participants aged 18 and over (response rate – 68.2% and 66.6% respectively). 1067 citizens, representing the entire population of Lithuania were selected and interviewed. The data were analyzed using the statistical package for social sciences (SPSS 16.0 for Windows). Chi square (χ²) test and disperse analysis ANOVA were used to determine the significant differences among socio-demographic characteristics of respondents, to measure changes between variables from 2009 to 2010 z statistical criterion was employed. The results revealed that majority of participants viewed the constitutional guarantee of the right to health service as “partially provided”, although this opinion improved in one year. During the second survey, more residents recognized that decisions regarding health care provisions were made regardless of or with little public consultation. One third of participants were convinced that all health services in Lithuania were related to out-of-pocket expenses, legally or illegally, and had made such payments once or several times within the past 12 months. More than 80% of citizens, especially the youngest and the eldest, were not aware of the differences, quality or similarities between brand name and generic medications. Almost half of the participants had no understanding of how The National Health Insurance Fund is used and nearly 30% confounds health insurance with social insurance. Rehabilitation institutions were rated as the best among health care institutions, while long-term care institutions were considered to provide the worst quality of care services. Nevertheless, confidence in the mandatory health insurance system is higher than average – 6.42 out of 10. Conclusion. The knowledge of the mandatory health insurance system in Lithuanian citizens is not sufficient, level of personal confidence is high but decreased within one year, level of public confidence in mandatory health insurance system remains high.