Saeima MPs Slam Health Ministry's Healthcare Registration Proposal

Members of the Saeima’s Social and Labour Affairs Committee on Tuesday criticised the Ministry of Health’s (MoH) revised amendments to the Health Care Financing Law, arguing that linking access to healthcare services to the fact of declared residence is an unclear solution that does not address the sector’s lack of funding. During the committee meeting, MPs stressed that the proposed approach does not increase healthcare funding and creates practical and legal uncertainty, particularly with regard to people who live and work abroad. The draft law proposed by the MoH requires abandoning the so-called two-basket healthcare system and instead basing state-paid healthcare on tax payment and residency principles. Under the proposal, entitlement to healthcare services within the framework of mandatory state health insurance would apply to persons who are socially insured for health insurance, as well as to certain groups of people who are not socially insured but have had a declared or registered place of residence in Latvia for at least one month. At the same time, the draft law provides for a number of exceptions for particularly protected groups, for whom healthcare would be ensured regardless of declaration or tax payment. In the discussion, MPs repeatedly pointed out that the declaration principle in itself has no connection to an increase in healthcare funding, as declaration is an administrative tool rather than a real source of revenue for the sector. It was also emphasised that declaring a place of residence is a voluntary action that is difficult to control effectively in practice. During the meeting, MPs also drew attention to data provided by the MoH showing that in 2024 Latvian citizens declared abroad received healthcare services in Latvia worth around three million euros. At the same time, it was noted that the total number of Latvian nationals living abroad is significantly higher, and that the declaration criterion alone does not reflect a person’s actual connection to the national healthcare system. Despite the explanations provided, committee members concluded that the proposed regulation does not contribute to increasing healthcare funding and does not meet the requirements previously expressed by the committee on several occasions. As a result, the committee did not even hold a vote on the draft law in its first reading and called on the MoH to continue work on proposals that would clearly define affected population groups and offer solutions to increase healthcare funding. MP Ingrīda Circene (New Unity) said that the declaration principle is incompatible with access to healthcare services, as it is linked to the payment of taxes to municipalities. “You are coming for the fourth time with a proposal that we have already rejected,” Circene said. She stressed that Latvian citizens living abroad can also be declared in Latvia, meaning this criterion is meaningless. “From your fourth presentation of the same proposal, not a single cent is added to healthcare,” she stated. Responding to the criticism, MoH Deputy State Secretary for Finance Boriss Kņigins explained that neither the year before last nor last year had it been possible to agree on a comprehensive review of the tax system. He acknowledged that the proposed amendments cannot be regarded as a conceptual solution to healthcare financing reform, but described them as one step toward directing primarily state-funded healthcare services to the groups defined in the draft law. He also noted that the declared residence principle is already used in other areas of public policy and is technically manageable, given the linkage of state information systems and the involvement of other ministries. MP Ramona Petraviča (Latvia First) pointed out that the draft law would effectively deny state-paid healthcare services to people working abroad, resulting in savings of about three million euros per year. In her view, this amount is insignificant, noting that, for example, the Children’s Protection Centre spends almost two million euros on advertising. Petraviča questioned where these savings would be redirected, arguing that state-funded healthcare would be provided to detained asylum seekers, people detained at the border and refugees Latvia will have to accept, while Latvian citizens working abroad—who return to Latvia, spend money, use services and send funds to relatives—would lose these rights. She emphasised that these people also contribute to tax payments. Kņigins explained that for persons staying in Latvia who are not considered Latvian nationals, access to healthcare is determined in accordance with European Union regulations and case law. According to court rulings, any EU citizen who enters Latvia and stays for more than three months without employment or income is entitled to state-paid healthcare. Under the proposed regulation, such persons would be required either to declare their residence in Latvia or to pay taxes, thereby meeting the criteria of the first group defined in the draft law. Circene countered that declaration depends on a person’s voluntary action and that anyone could declare residence in Latvia within minutes from another country. Kņigins replied that this is why the Ministry of the Interior should be involved to clarify declaration rules, as it is not the case that just anyone can simply declare residence—this is regulated by law and falls under the responsibility of the Interior Ministry. The MoH representative stressed that the solution applies only to Latvian nationals, while for third-country nationals access to services would be possible only through tax payments. He also argued that if a person wishes to pay taxes in another country, they must deregister from Latvia to avoid double taxation. MPs objected to this, noting that “this is not how things work in real life.” Kņigins responded that failures in practice are not the responsibility of the MoH but of other institutions that should ensure accountability in such cases. MP Līga Rasnača (Progressives) pointed out that such a solution would be easier to apply within EU countries due to information exchange, but far more complicated in the case of the United Kingdom and third countries. The committee asked the MoH to prepare, within two weeks, an overview of the population groups that would be affected by the proposed changes, while also calling for solutions to increase overall healthcare funding. Meanwhile, MPs supported in the first reading another draft law considered at the meeting—amendments to the Pharmacy Law prepared by the Ministry of Agriculture. The amendments aim to clarify the mandate of the Food and Veterinary Service in collecting data and compiling statistics on the circulation of veterinary medicines, including the use of human medicines in animals, and to strengthen the functions and objectives of the veterinary medicines register and the veterinary e-health information system (eVETIS). The goal of the draft law is to ensure compliance with EU regulations, including digital data registration and reporting to EU databases, improve oversight and traceability of veterinary medicines, and reduce the risk of antimicrobial resistance. Read also: Costs rise, deadlines slip: EU auditors sharply criticise Latvia’s Rail Baltica, Ministry responds