I’ve just returned from a brief research trip to Lithuania, which wasn’t focused on health care. But while I was there, I had the opportunity to discuss the Lithuanian health care system with a colleague who runs the district health center of a small Lithuanian city.
I learned that Lithuania, like most of Europe and the developing world, has a single national compulsory insurance fund, so everyone has a way to pay for health care. Working people contribute from their wages or income. The government pays for health care for children, retirees, students, unemployed people registered with employment services, people with disabilities and certain caregivers and other protected groups. But government does more than just provide insurance. In Lithuania, the government also employs doctors and nurses in public clinics and hospitals that provide most of Lithuanians’ health care. There is also a private system, but most people use the public system. That means that all Lithuanians have primary care, and no one has to worry about paying for their health care or going bankrupt should they get sick.
In 2024, Lithuanians spent about $4259 per person per year on health care. We spent about $14,880 in that year.
Their infant mortality rate, a common measure of health care system performance, is about half ours for white Americans and one quarter of the rate for Black Americans. Their life expectancy, another measure of health care, is just a little lower than ours. Lithuania ranks between 50th and 55th in the world, while we rank between 47 and 49th, despite our spending about twice as much, per person, than other developed nations spend, and spending more than three times what the Lithuanians spend. But life expectancy for Lithuanian women is longer than life expectancy for American women – about a year longer, and about five years longer than for Black American women. (Life expectancy for white American women is about four years longer than for Black American women.) All that is because men in Lithuania have a life expectancy more than 8 years shorter than women. Smoking, heart disease, alcoholism, accidents and suicide are real problems for Lithuanian men.
(On the other hand, my colleague in Lithuania, who is knowledgeable about public health in the US, commented on the obesity of our population. You need to outlaw junk food and big portions, she said. (She couldn’t believe the size of our restaurant portions.) What you do is crazy, she said. Overfeed people with terrible food. And then put hundreds of thousands of people on very expensive medications like Wegovy and other GLP-1 agonists to help control weight.)
But here’s what else is crazy about health care in Lithuania: they don’t have enough doctors either. It turns out the European Union is short about 500,000 health care workers today, much like the US, proportionally. They are using nurses for more and more health care because of this shortage — and getting good results. They use nurses for all the care of children under one year old, for example. And have had great success doing that.
So it turns out there is a worldwide shortage of health professionals. We poured money into research and development, so we have many more drugs and tests and are way better at preventing disease, at least for those people who have a primary care clinician to tell them how to prevent preventable disease. And the world population has been increasing. All of which means we have a much greater need for health professionals in every country. Even so, most countries have failed to invest in training the more health professionals we all need.
Thus, we are spending bags and bags of money designing ways to help people be healthier. But we, and many other countries, aren’t doing a good job getting what works to the people who will benefit from it, because none of us are training enough of the young people we need to do the work. Sort of like inventing Amazon and Walmart to get people all the stuff they need, delivered today or tomorrow. But forgetting to build trucks and hire drivers. Or like having a very good birthing center. But not having doctors, midwives, and doulas to staff it, just sayin.
That’s crazy.
You can find Michael Fine’s commentaries and short stories on
https://michaelfinemd.substack.com/and on http://www.michaelfinemd.com
