Lithuania

The 60 municipalities (savivaldybė), varying in size from less than 5000 people to over 500 000, are responsible for organizing the provision of primary and social care, and for public health activities at the local level.  

The two main revenue sources of the NHIF consist of a compulsory earmarked contribution from payrolls, and direct transfers from the state to cover (mostly) economically inactive population groups, such as children, students, pensioners and unemployed people. In addition, the state budget covers long-term care at home, health administration, education and training, capital investment and public health services. OOP payments consist mostly of direct payments because the role of Voluntary Health Insurance is very small, albeit increasing. 

In the Lithuanian system, primary care routinely acts as a first contact point with the health system for patients. It is delivered in public or private health care centres, where general practitioners (GPs) often practise alongside other primary care specialists such as paediatricians, gynaecologists and mental health practitioners. Primary care physicians play a gatekeeping function to more intensive levels of care; however, patients can go directly to specialists practising in publicly-financed settings. Specialist outpatient care is delivered by the outpatient departments of hospitals or polyclinics, as well as by private providers.