title: Access to care in the Baltic States: did crisis have an impact?
abstract: BACKGROUND
  In 2009, brief but deep economic crisis profoundly affected the three Baltic States: Estonia, Latvia and Lithuania. In response, all three countries adopted severe austerity measures with the shared goal of containing rising deficits, but employing different methods.
  
  
  OBJECTIVE
  In this article, we analyze the impact of the economic crisis and post-crisis austerity measures on health systems and access to medical services in the three countries.
  
  
  METHODS
  We use the EU-SILC data to analyze trends in unmet medical need in 2005-2012, and apply log-binomial regression to calculate the risk of unmet medical need in the pre- and post- crisis period.
  
  
  RESULTS
  Between 2009 and 2012 unmet need has increased significantly in Latvia (OR: 1.24, 95% confidence interval (CI): 1.15-1.34) and Estonia (OR: 1.98, 95% CI: 1.72-2.27), but not Lithuania (OR: 0.84. 95% CI: 0.69-1.04). The main drivers of increased unmet need were inability to afford care in Latvia and long waiting lists in Estonia.
  
  
  CONCLUSIONS
  The impact of the crisis on access to care in the three countries varied, as did the austerity measures affecting their health systems. Estonia and Latvia experienced worsening access to care, largely exacerbating already existing barriers. The example of Lithuania suggests that deterioration in access is not inevitable, once health policies prioritise maintenance and availability of existing services, or if there is room for reducing existing inefficiencies. Moreover, better financial preparedness of health systems in Estonia and Lithuania achieved some protection of the population from increasing unmet need due to the rising cost of medical care.
authors.affiliation: European Observatory on Health Systems and Policies, London, UK The Centre for Health and Social Change (ECOHOST), London School of Hygiene and Tropical Medicine, London, UK marina.karanikolos@lshtm.ac.uk.
authors.forename: Marina
authors.initials: M
authors.lastname: Karanikolos
authors.affiliation: Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, The Netherlands.
authors.forename: Vladimir S
authors.initials: VS
authors.lastname: Gordeev
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
authors.forename: Johan P
authors.initials: JP
authors.lastname: Mackenbach
authors.affiliation: European Observatory on Health Systems and Policies, London, UK The Centre for Health and Social Change (ECOHOST), London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: McKee
mesh_terms: D001454:Baltic States; D057172:Economic Recession / Q000706:statistics & numerical data*; D006292:Health Priorities / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006801:Humans; D012959:Socioeconomic Factors; D013997:Time Factors; D014850:Waiting Lists