Browsing by Author "Bikava, Ieva"
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Item Cooperation and Collaboration Impact on Policy Development : HIV/AIDS policy in Latvia(2019) Bikava, Ieva; Kreituse, Ilga; Politikas zinātnes katedraThis article describes a case study of trends of governance approach implementation in the health policy development and implementation process in Latvia, in the state in transition, or “new democracy”. Latvia became an independent democratic state in 1991, regaining its freedom after being part of the Soviet Union for 50 years. As the three Baltic States (Latvia, Lithuania, and Estonia) had a common history and starting point in the health reform implementation, the data of Human Immunodeficiency Virus (HIV) incidence and implemented policy steps were analyzed and compared of all the three states. The research provides insight into the HIV/Acquired Immune Deficiency Syndrome (AIDS) situation in Latvia from the time when the first patient was diagnosed till nowadays, describing the initiatives that were implemented to combat the spread of HIV infection and analyze the impact of different stakeholders in the policy development and implementation process. Although the main reform implementation actors in Latvia were Non-Governmental Organizations (NGOs) or patient organizations by performing cooperation and collaboration with all the actors involved in the policy development and implementation process, more profound investigation reveals that major impact came from “old democracies”, international and global organizations as well as from physicians and commercial powers by providing a suitable environment for the reform development.Item Health care accessibility and disparities in medical staff availability in Latvia(2019) Bikava, Ieva; Skride, Andris; Berķis, U.; Vilka, L.; Rīga Stradiņš University; Department of Internal DiseasesThe Health care accessibility for inhabitants, especially in rural regions, is related to the problem of the medical staff availability in state and municipal hospitals and ambulatory institutions as well as for General Practitioners. Despite the fact, that there are two state Universities – University of Latvia and Rıga Stradiņš University, as well as colleges, that educate medical staff – there is a lack of human resources in health care institutions in Latvia. The Ministry of Health and municipalities had several initiatives to solve this problem – changes in regulations for Residency students, programme financed by European Funds with obtainable funding in the amount of 10 million euro, as well as different stimuli and programmes from municipalities. The research explores the current situation with staff availability and, basing on interviews and outcomes, analyzes the effectiveness of the available programmes to attract human resources, and predict the impact and outcomes of those activities. The results showed that all the programmes had some fragmented positive impact and partially solve the problem, but those activities will not provide sufficient outcomes and the problem of medical staff availability will still be the urgent topic in future.Item Health Policy Reform in Latvia from 1990 to 2020 in Perspective of Historical Institutionalism. Summary of the Doctoral Thesis(Rīga Stradiņš University, 2023) Bikava, Ieva; Bukovskis, KārlisDevelopment of the Health politics as well as implementation of different changes in health policy in Latvia has been a topical issue since the year 1990, when Latvia regain its independency from USSR. Successful development, acceptance and implementation of the policy change is one of the most significant functions of public administration. Analysis of the basic values and ideas of the health policy in health care in democratic states during the last 30 years has been not changed: to ensure health system that provides health care accessibility to citizens. By this providing accessibility in terms of geographical as well as timely and affordably way, at the same time providing appropriate quality in compliance with the contemporary worldwide standards as well as according to available funding, developing the model that provides that the money is used in the most effective and efficient way. According to the indicators of the health system performance – in Latvia the goals of the health reform by changing the healthcare providing model, has not been achieved, and in comparison to other EU states, Latvia is lagging far behind the other states, even the neighboring countries – Estonia and Lithuania, with whom Latvia was in the same starting positions at the year 1990. The objective of the thesis “Health Policy Reform in Latvia from 1990 to 2020 in Perspective of Historical Institutionalism” is to analyze healthcare reform of Latvia in the period form 1990 to 2020 from the perspective of Historical Institutionalism and to provide answers to three research questions: 1) what changes in health policy were implemented in the scope of the reform; 2) what objectives of the reform were achieved; 3) why the achievement of the goals were delayed in reforming health policy of Latvia in the period from 1990 to 2020. First chapter provides description of the Historical Institutionalism – theoretical approach that is chosen as the basis for this research. The second chapter provides contextual description and research methodology. The third chapter provides the analysis of the health reform analyse, consisting of two parts. The first characterizes changes in health policy that were implemented during the reform and their outcomes. The second part analyses the policy process in order to identify hindering factors in reform implementation process. Conclusion chapter provides the summary of the research results and observations.Item How will future health policy impact on regional disparities and healthcare in Latvia(EDP Sciences, 2019) Bikava, Ieva; Kreituse, Ilga; Berķis, Uldis; Vilka, Lolita; Rīga Stradiņš University; Politikas zinātnes katedraLatvia is a country with high level of regional disparities and as researches have approved – income, education, and environment significantly affect the status of people's health. The reforms in healthcare have been carried out under the flags of accessibility, efficiency, effectiveness, and quality since 1991. Some groups support the idea that the state should take over almost all services, the others claim that more responsibilities should be transferred to the private sector, and dispute on service provider network and financing system. In accordance with the coalition theory and legislation of Latvia, the initiators and designers of the structural reforms are politicians, elected by the citizens. In theory, every politician represents the political party with its ideology and vision that is expressed in the Programme of the party. Due to Parliament elections in 2018, to understand which way the country will go, and how the chosen strategy will impact on the regional disparities, analysis of the middle-term development strategy was made. Research results showed that political parties in Latvia are not based on the ideology and the strategical development vision of the State, so the development and changes made in legislation are mainly ad-hoc decisions or the result of lobbying activities of influential groups. Due to the lack of middle term vision as the gap between long-term development strategy and short-term decisions, unfortunately, the prognosis of future health politics leads to the conclusion that regional disparities and the problem with Health care accessibility in next decades will only rise. Key words: health policy / regional disparities / political party ideologyItem LATVIA’S DOCTORS EXPERIENCE ON PROVIDING REMOTE CONSULTATIONS DURING COVID-19 PANDEMICS(2022-06-01) Jeniceka, Aleksandra; Homka, Dzintra; Bikava, Ieva; Sen, Sevinç Elif; Sokolova, Emma; Rīga Stradiņš UniversityObjective: Major challenge for health care service became a situation of a pandemic caused by COVID-19 infection, when doctors continued to provide care switching to remote consultations when possible. This provided better accessibility to receive consultation form doctor, and those consultations where sometimes the only way to be consulted for the patient.Aims of the study: To explore and analyze Latvia's doctors experience on providing remote consultations during COVID-19 pandemics.; Objective: 1) To detect the volume and type of work physicians are able to manage remotely. 2) To find out what technical, GDPR-associated and other difficulties face doctors during the process. 3) To define the general attractiveness of remote consulting.; Design and Method: Two groups of doctors filled in the questionnaires in year 2021.; Results: In one group, which consisted of 200 general practitioners, most respondents consider they could provide remote medical consultation about healthy lifestyle - 89,0% (n = 178); regarding check-ups, screening results - 86,5% (n = 173); to manage recommendations of other healthcare specialists - 66% (n = 132). Difficulties faced: 54,0% (n = 108) were not satisfied with payment, 22,5% (n = 45) admitted lack of specific skills, 45,5% (n = 91) found it problematic to make e-referrals. 61,0% (n = 122) like the idea of implementing services in practice on a regular basis. Another group, which consisted of 62 doctors of different specialties working in Clinical University Hospital. All doctors (62) were consulting by phone, 18 doctors only by phone, however 44 were consulting via e-mails, social network on video-conference platforms as well.Research revealed that the process of patient identification, search of patient's data and sensitive data transfer is complicated, time consuming and requires different approaches to manage.; Conclusions: Latvian doctors have experience in remote consulting. When consulting remotely Latvian doctors were facing technical, legal, social and other difficulties. Some Latvian doctors are interested in introducing remote consulting services in their practice, if the restrictive moments for their provision would be eliminated. As well as there is need for amendments in normative regulation for providing remote consultations, and challenges relates to payment system implementations especially for state paid services. (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)Item Latvijas veselības politikas reforma no 1990. līdz 2020. gadam vēsturiskā institucionālisma skatījumā. Promocijas darba kopsavilkums(Rīgas Stradiņa universitāte, 2023) Bikava, Ieva; Bukovskis, KārlisVeselības politikas reforma veselības aprūpes sistēmā Latvijā ir aktuāla kopš neatkarības atgūšanas 1990. gadā, kad, atjaunojot Latvijas neatkarību, tika uzsākta veselības reforma, īstenojot veselības aprūpes modeļa maiņu. Politisko pārmaiņu veiksmīga izstrāde, pieņemšana un ieviešana ir viena no būtiskākajām valsts pārvaldes funkcijām. Veselības politikas un īstenoto reformu pamatpostulāti demokrātiskās valstīs šo 30 gadu laikā bijuši nemainīgi – nodrošināt iedzīvotājiem pieejamu, efektīvu un modernu veselības aprūpi. Arī reformu uzdevumi bijuši nemainīgi: nodrošināt iedzīvotājiem veselības aprūpes pieejamību atbilstoši mūsdienu pasaules standartu prasībām un pieejamā finansējuma iespējām, uzlabot veselības aprūpes pārvaldību, nodrošinot labāko izmaksu efektivitātes modeli. Tomēr, kā rāda veselības politiku raksturojošie rādītāji, Latvijā joprojām nav sasniegti veselības politikai izvirzītie mērķi, īstenojot reformu un mainot veselības aprūpes modeli, bet salīdzinošajos rādītājos veselības aprūpe Latvijā joprojām būtiski atpaliek ne vien no vidējiem ES valstu rādītājiem, bet arī salīdzinājumā ar kaimiņvalstīm Lietuvu un Igauniju, ar kurām Latvija 1990. gadā bija līdzvērtīgās pozīcijās. Promocijas darba mērķis ir izvērtēt Latvijas veselības aprūpes reformu laikposmā no 1990. līdz 2020. gadam vēsturiskā institucionālisma skatījumā un sniegt atbildes uz trim pētnieciskajiem jautājumiem: 1) kādas veselības politikas pārmaiņas tika realizētas veselības aprūpes reformas ietvaros; 2) kādi reformas mērķi tika sasniegti, veicot veselības aprūpes sistēmas reformu; 3) kāpēc kavējas izvirzīto mērķu sasniegšana, reformējot Latvijas veselības politiku laikposmā no 1990. līdz 2020. gadam. Darbā ir veikta Latvijas veselības reformas īstenošanas procesa analīze, kas tika veikta, pārejot no PSRS centralizētās plānveida veselības aprūpes modeļa uz decentralizētu veselības aprūpes sistēmu. Darbā raksturotas pārmaiņas un to rezultāti, vērtējot reformas mērķu sasniegšanu, kā arī sniegtas atbildes uz jautājumu, kāpēc kavējās reformas izvirzīto mērķu sasniegšana. Darba pirmajā nodaļā sniegts izvēlētās teorētiskās pieejas vēsturiskā institucionālisma izvēles pamatojums un raksturojums. Otrajā nodaļā dots kontekstuālais apraksts un pētījuma metodoloģija. Trešajā nodaļā veikta veselības reformas analīze, kuru veido divas daļas. Pirmajā daļā ir apskatītas Latvijas veselības aprūpes sistēmas izmaiņas un to rezultāti, savukārt otrajā daļā veikta politikas ieviešanas procesa analīze, lai identificētu veselības reformas mērķu sasniegšanu kavējošos faktorus. Darba secinājumos ir apkopoti analīzes rezultāti un novērojumi.Item Latvijas veselības politikas reforma no 1990. līdz 2020. gadam vēsturiskā institucionālisma skatījumā. Promocijas darbs(Rīgas Stradiņa universitāte, 2023) Bikava, Ieva; Bukovskis, KārlisVeselības politikas reforma veselības aprūpes sistēmā Latvijā ir aktuāla kopš neatkarības atgūšanas 1990. gadā, kad, atjaunojot Latvijas neatkarību, tika uzsākta veselības reforma, īstenojot veselības aprūpes modeļa maiņu. Politisko pārmaiņu veiksmīga izstrāde, pieņemšana un ieviešana ir viena no būtiskākajām valsts pārvaldes funkcijām. Veselības politikas un īstenoto reformu pamatpostulāti demokrātiskās valstīs šo 30 gadu laikā bijuši nemainīgi – nodrošināt iedzīvotājiem pieejamu, efektīvu un modernu veselības aprūpi. Arī reformu uzdevumi bijuši nemainīgi: nodrošināt iedzīvotājiem veselības aprūpes pieejamību atbilstoši mūsdienu pasaules standartu prasībām un pieejamā finansējuma iespējām, uzlabot veselības aprūpes pārvaldību, nodrošinot labāko izmaksu efektivitātes modeli. Tomēr, kā rāda veselības politiku raksturojošie rādītāji, Latvijā joprojām nav sasniegti veselības politikai izvirzītie mērķi, īstenojot reformu un mainot veselības aprūpes modeli, bet salīdzinošajos rādītājos veselības aprūpe Latvijā joprojām būtiski atpaliek ne vien no vidējiem ES valstu rādītājiem, bet arī salīdzinājumā ar kaimiņvalstīm Lietuvu un Igauniju, ar kurām Latvija 1990. gadā bija līdzvērtīgās pozīcijās. Promocijas darba mērķis ir izvērtēt Latvijas veselības aprūpes reformu laikposmā no 1990. līdz 2020. gadam vēsturiskā institucionālisma skatījumā un sniegt atbildes uz trim pētnieciskajiem jautājumiem: 1) kādas veselības politikas pārmaiņas tika realizētas veselības aprūpes reformas ietvaros; 2) kādi reformas mērķi tika sasniegti, veicot veselības aprūpes sistēmas reformu; 3) kāpēc kavējas izvirzīto mērķu sasniegšana, reformējot Latvijas veselības politiku laikposmā no 1990. līdz 2020. gadam. Darbā ir veikta Latvijas veselības reformas īstenošanas procesa analīze, kas tika veikta, pārejot no PSRS centralizētās plānveida veselības aprūpes modeļa uz decentralizētu veselības aprūpes sistēmu. Darbā raksturotas pārmaiņas un to rezultāti, vērtējot reformas mērķu sasniegšanu, kā arī sniegtas atbildes uz jautājumu, kāpēc kavējās reformas izvirzīto mērķu sasniegšana. Darba pirmajā nodaļā sniegts izvēlētās teorētiskās pieejas vēsturiskā institucionālisma izvēles pamatojums un raksturojums. Otrajā nodaļā dots kontekstuālais apraksts un pētījuma metodoloģija. Trešajā nodaļā veikta veselības reformas analīze, kuru veido divas daļas. Pirmajā daļā ir apskatītas Latvijas veselības aprūpes sistēmas izmaiņas un to rezultāti, savukārt otrajā daļā veikta politikas ieviešanas procesa analīze, lai identificētu veselības reformas mērķu sasniegšanu kavējošos faktorus. Darba secinājumos ir apkopoti analīzes rezultāti un novērojumi.Item TELEMEDICINE AND HEALTH POLICY CHANGES IN RESPONSE TO RESTRICTIONS RELATED TO COVID-19 PANDEMICS IN LATVIA(2022-06-01) Sen, Sevinç Elif; Sokolova, Emma; Jeniceka, Aleksandra; Bikava, Ieva; Rīga Stradiņš UniversityObjective: Remote consultations are quickly emerging to give more access to real-time, high-quality, efficient, and cost-effective healthcare in the current COVID-19 pandemic.Objective is to investigate the changing experiences of remote consulting for patients in Latvia and plan effective health policies, to provide a full analysis of the policy for telemedicine applications and solutions based on the current conditions.; Design and Method: Materials and approaches include an examination of normative documents as well as a variety of informational sources. The information offered is mostly based on national strategy papers, official reports, and scientefic publications on Tele-medicine implementation.; Results: Telemedicine's range will continue to expand, connecting patients and providers internationally as providers look to expand globally. This will not only help improve the long-term policies about health but may also provide patients with rare diseases alternative avenues to seek highly specialized care. Telemedicine strategy must react faster than ever during the COVID-19 epidemic. Latvia has reacted to Covid pandemics and have noticable implemented new possibilities to provide new approaches provided by telemedicine: providing remote consutlations to patients in different sectors, using E-referrals that were implemented but not sufficiently used before, providing more possibilites to provide remote services also for consiliums, physician-physiscan online consultations. New ICT tools were used for patient remote monitoring. The normative regulation, stategical decisions and changes in long-term policy documents haven't been changed, so there are limitations to provide the telemedice expansion or stable use after the emengency situation ends. Health policies about telemedicine have another key role with to pursuing that.; Conclusions: Telemedicine is fast expanding, demand for this service is rising. Although not a replacement for face-to-face consultations, this study illustrates that remote consulting can be an acceptable adjunct to traditional face-to-face consultations. More research is required to identify overall safety and applicability. Digital Health Strategy in Latvia is still on developing stage. Changes or legislation to clarify Telemedicine are still in the process. It is important to provide a good environment for Telemedicine to expand, setting strategies and visions on how those new approaches will be regulating normatively and administratively. (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)Item The voice of society in healthcare politics in Latvia(2020-01-01) Bikava, Ieva; Kreituse, Ilga; Skride, Andris; Vilka, L.; Vike, J.; Rīga Stradiņš UniversityIt is impossible to imagine contemporary democracy without society participation in the process of developing regulations and implementation of changes that have a significant impact on society. The opinion of the society is represented by social communities, interest groups, and other non-governmental organizations, which unite people with similar views and ideas and serves as a representative of common opinion to government. The principles of good governance demand cooperation and collaboration with society in all phases of developing, implementing and assessing changes in any policy. The article represents the research on evaluation of cooperation and collaboration practice, as well as an assessment of used lobbying strategies and evaluation of their results in Healthcare politics in Latvia. The research is based on in-depth interviews with the representative of main actors presenting the NGO sector, as well as the representatives of the Ministry of Welfare. The research results indicated that actors that operate in Healthcare sector use all of the possible lobbying techniques with various outcomes. The achieved results are dependent on the skills and available resources of Interest groups, on the desire and possibilities to follow good governance principles in state authorities, as well as of the topical issue.