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Payments from the Medical Risk Fund are critically important for many patients as such payments allow them to act immediately to mitigate and prevent the consequences of damage they have suffered. In some cases, the Medical Risk Fund deals with complaints and compensation claims for so long that the money is eventually paid to the heirs of a patient, the Audit Office points out.

In five years since the Medical Risk Fund was established, the center has received more than 900 patients' compensation claims, made more than 200 decisions confirming harm done to the patients during the treatment, and paid these patients a total of EUR 4.4 mln. The Audit Office assessed accessibility of the Medical Risk Fund, how long patients' claims are analyzed, transparency of the procedure for determining the amount of reimbursement, and management of the fund's financial resources.

The Medical Risk Fund's ultimate goal is to enable patients to defend their rights without the need to turn to courts. The fund is a state institution, but its operations directly depend on the speed of the Health Inspectorate and National Health Service's operations and these two institutions' capacity.

In order for a patient to be eligible for compensation for the harm he or she has suffered, the patient must apply to the Medical Risk Fund and describe the damage suffered. The fund must make sure that all the required documents are submitted and that the deadlines for submitting the claim are met, after which the Health Inspectorate analyzes the case and determines the scale of damage. The Medical Risk Fund then makes a final decision whether to pay or not pay compensation to the patient. The entire process may take up to six months. However, deadlines are actually observed only in less than a quarter (24%) of all cases. In cases where additional time is required to assess the circumstances, the process may take up to one year, while in 33% of all cases, the process continued for more than a year, the Audit Office has established.

The majority of this time - 90% - is taken by the Health Inspectorate's examinations and preparation of the inspectorate's opinion. Furthermore, the Health Inspectorate's inspections have been growing longer - back in 2014, one such inspection took eight months on the average, while in 2017 - more than a year. This is due to the Health Inspectorate's limited capacity and poorly planned internal procedures.

The audit found that lack of medical experts has a significant impact on Health Inspectorate's operations, which is a problem characteristic of the entire healthcare industry. In order to tackle the problem, at the end of last year the inspectorate began to conclude agreements with professional associations and external experts.

At the same time, the overly general regulatory framework for determining the severity of damage to the health of a patient also hampers speedy review of claims - the regulations are so complex and unclear that patients cannot trace and understand the method of how the amount of damage was calculated. As a result, patients will consider the payments unfair in all cases except the cases when the maximum possible amount of compensation is paid.

According to the Cabinet of Ministers' regulations, the Medical Risk Fund must calculate the annual amount of compensation payments taking into account the expected number of claims. However, the fund does not actually make such projections and instead relies on the original projections defined in 2013.

At present, financial flows at the Medical Risk Fund do not suggest that the fund has ever been short of money necessary to pay a patient compensation. However, one of the reasons for that is the delayed decision-making process - furthermore, the fund is not held responsible if a patient's claim is reviewed too long. If the process of reviewing claims were shorter, the fund could at some point run out of cash for compensation payments.

The other reason why money remains at the Medical Risk Fund is that many people do not know about the existence of the fund and about their rights. According to the Audit Office's survey, only 14 % of respondents have heard that such there is such a fund in Latvia, and only 9 % know what the main function of the Medical Risk Fund is.

The Health Ministry has never assessed the Medical Risk Fund's performance, although the ministry has sufficient information about all the shortcomings ascertained by the Audit Office. 18 % of the fund's decisions are appealed to the Health Ministry and at least 48 % of them are subsequently appealed in the Administrative Court.

In order to ensure that the Medical Risk Fund's operations meet the main objective of the fund, the Audit Office recommends the Health Inspectorate and the Health Ministry to take measures in order to improve internal and control procedures, as well as measures aimed at improving review of patient's claims.