Pay demands by medical staff spread

During October 2004, a campaign for higher pay and shorter working hours launched by anaesthetists spread to other medical staff in Latvia, who are planning to cut their working time to a level they regard as being accordance with their pay and the law.

In September 2004, doctors working as anaesthetists called for higher pay and shorter working hours (in accordance with the law) (LV0410101N), and stated that from November they would unilaterally cut their working time and workload to levels they regard as being accordance with their pay and the law. Doctors in many other specialisms have joined the campaign. In response to the anaesthetists’ demands, the government promised to find additional funds in the 2004 state budget and to speed up the completion of current healthcare reforms. This will involve 'optimising' the network of healthcare bodies, meaning that several hospitals will be closed. The government also mentioned increased payments for treatment by patients as a possible source of improved funding.

The doctors rejected the government’s offer as unsatisfactory, arguing that there is not too much healthcare infrastructure and that although provision was once considered as being over generous, as a result of reforms and economic problems in the sector it has in fact become worse than the EU average. Also, it is claimed, patients' financial participation is already so high that access to healthcare is threatened. Every year public health indicators in Latvia are worsening, and have reached critical levels, the doctors assert.

Inadequate funding forces doctors to take illegal payments, and the prevalence of such 'under the table' wages almost appears to be considered normal. For example, 47% of businesspeople recently surveyed by the Dienas bizness newspaper said that they have given cash payments to doctors (usually EUR 75 or more), and will keep doing this, viewing doctors’ wages as too low.

As the government appears unable to resolve the situation, dissatisfaction is spreading among medical staff. On 19 October 2004, the Health and Social Care Workers' Trade Union (Latvijas Veselības un sociālās aprūpes darbinieku arodbiedrība, LVSADA) adopted a resolution calling on nurses to cease performing additional work from 1 January 2005 and demanding that their wages be increased to EUR 440 per month. The union reports that the current monthly wage for a nurse working a full shift is EUR 173 before tax. Some 50%-60% of nurses perform extra work outside their normal working hours without receiving 100% pay premium for overtime as laid down in the Labour Law. Nurses receive wage supplements only for night work and for hazardous work. Due to overwork, LVSADA claims, the number of work-related illnesses recorded among healthcare workers has increased by a factor of 7.6 over the last six years. The October resolution is only a suggestion, and the nurses themselves will decide on what action to take. The resolution also calls on nurses to file court cases over infringements of Labour Law provisions on overtime payments that have occurred in 2003 and 2004.

Furthermore, the Latvian Emergency Medical Assistance and Disaster Medicine Association (Latvijas Neatliekamās medicīniskās palīdzības un katastrofu medicīnas asociācija, LRNMPKMA) is calling for the lowest monthly wage for emergency medical workers to be doubled.

A meeting with the doctors' representatives was held on 20 October 2004, involving the Prime Minister, Indulis Emsis, and Minister of Health, Rinalds Muciņš. As before, the government promised a wage increase only as a side-effect of introducing hospital reform and does not expect to be able to find extra funds for wage increases. The doctors believe that the government is not trying to find a solution, and therefore the negotiations have not led to any development that would cause the anaesthetists and other specialists to reconsider their plan to reduce their working hours from November. Antoņina Sondore, president of the Anaesthesiologists and Reanimatologists of the Republic of Latvia (Latvijas Republikas Anesteziologu un Reanimatologu asociācija, LARA), told the newspaper Diena, 'I foresee that this action will create victims', because there will be a shortage of medical personnel at hospitals due to the action. The doctors consider the Prime Minister’s comments on the possibilities for resolving the crisis as heralding the start of direct payment for medical care in Latvia.

In November, the Ministry of Health was due to submit a reform plan to the cabinet. The Ministry is planning to raise a EUR 44 million loan for the first step of implementing the hospitals reform plan.