The chapter provides an overview of the main challenges for PHC and LTC services in Tauragė+ functional zone, which is a voluntary initiative between the four municipalities of the area with the aim to provide an integrated response to common issues. As part of the selected areas for co-operation within the functional zone, PHC and LTC services have been selected to be piloted in partnership with the four municipalities, the MoH and MSSL. Two roadmaps are presented in the chapter to provide practical steps for policymakers and relevant stakeholders at the municipal level to pilot the services in the functional zone, and thus to improve the availability, accessibility, affordability and acceptability of PHC and LTC services.
Enabling Inter‑Municipal Shared Service Provision in Lithuania
Proposed Legal and Institutional Framework and Piloting Approach in Tauragė+ Functional Zone
Abstract
Tauragė+ functional zone is a voluntary and bottom-up initiative that has been made by the four municipalities of the area (Tauragė district municipality, Jurbarkas district municipality, Pagėgiai district municipality and Šilalė district municipality) with the aim to provide an integrated response to common problems. The functional zone has been established by the agreement signed by the four municipalities early 2020, which has been formalised by the decisions of the municipal councils of the functional zone that approved the Development Strategy for the Tauragė+ functional zone1, and outlined priority areas for co-operation. Among the selected areas for co-operation are the improvement of access to public services, which notably include transport, wastewater management, healthcare and social services (Tauragė district municipality, 2023[1]). Transport was the first public service to be piloted within the functional zone since it stands as an essential prerequisite for better accessibility to services. PHC and LTC have subsequently been selected for piloting in partnership with the four municipalities, the MoH and MSSL.
5.1.1. Overview
Tauragė+ functional zone comprises four municipalities: Tauragė district municipality (37 403 inhabitants in 2022), Jurbarkas district municipality (24 688 inhabitants), Pagėgiai municipality (7 236 inhabitants) and Šilalė district municipality (21 586 inhabitants). Tauragė serves as the administrative centre. Tauragė functional zone is the smallest area in Lithuania in terms of population. The population in Tauragė functional zone decreased by 28% from 2008 to 2022, compared to the national average of -15%. In Tauragė functional zone, Šilalė district municipality experienced the most significant population drop (Statistics Lithuania, 2023[2]).
The land area of Tauragė functional zone (4 411 km2) accounts for 6.7% of the country's total area. The Jurbarkas district municipality is the largest by area in Tauragė functional zone, covering 1507 km2 (34% of the Tauragė functional zone), while Šilalė and Tauragė districts cover 27% each. The smallest is the Pagėgiai municipality at 12% of the total area. Tauragė functional zone is predominantly rural, with remote settlements in terms of geographical distance. In 2021, the population ratio between urban and rural municipalities was 43:57, lower than the national average. The population density of 20.4 inhabitants/km2 in 2021 was more than two times lower than the national average.
5.1.2. Current and future challenges in PHC and LTC services in Tauragė+ functional zone
Ageing and shrinking population pressures the provision and funding of PHC and LTC services
Municipalities in Tauragė+ functional zone grapple with an ageing and shrinking population, necessitating the integration of tailored services for the elderly. There are also difficulties in hiring full-time professionals, particularly junior doctors (i.e., a qualified doctors practising between graduation and completion of specialist postgraduate training).
Increasing demand for PHC clashes with a shortage of specialist doctors and other medical staff, a lack of investment in healthcare premises and modern equipment, as well as poor quality and low access to healthcare services, causing lengthy waitlists (Tauragė district municipality, 2023[1]). Day-care centres, significant for community health and socialization, primarily serve the physically and mentally disabled, overlooking the elderly.
Palliative care needs persist across the functional zone, and municipalities aim to shift from LTC beds in hospitals towards more outpatient and home-based services. However, this shift is still emerging, hampered by challenges in attracting skilled staff and separate funding for health and social care for meeting additional demand.
Health and social care are organised as separate, mainly because they are guided by two separate ministries (MoH and MSSL) and funded differently (Box 5.1). In reality, the line between them is blurry. Health and social care workers often share information about their patients' needs informally during home visits, but there is no official teamwork in integrated service provision at the local level. There is a clear need in the future for better integration, in both how they work and how they're organised.
As all municipalities in Lithuania are following the national setup, we provide the whole overview of the organisation of this setup for better understanding for future reforms in services provision in specific regions (e.g., Tauragė+ functional zone as selected for the pilots).
The current organisation of healthcare and social services in Lithuania
The Ministry of Health (MoH) and the National Health Insurance Fund (NHIF) are the main central institutions for healthcare, while municipalities have an important role in services delivery (OECD, 2018[3]).
The MoH is responsible for formulating health policy and regulations, and managing the NHIF, large hospitals and the network of subordinated institutions (e.g. the State Health Care Accreditation Agency, the State Medicine Control Agency).
The NHIF purchases personal healthcare services on behalf of the insured population and provides insurance coverage to the population for health prevention, primary healthcare, specialist services, nursing and rehabilitation, reimbursement for medicines and medical devices (OECD/European Observatory on Health Systems and Policies, 2021[4]).
Municipalities play a key role in service delivery as they own a large share of primary care centres, especially polyclinics, and small-to-medium sized hospitals. Municipalities are responsible for providing PHC services (e.g. family doctors, diagnostics, preventive programs, paediatrics), as an independent function, and for providing public and secondary healthcare in certain cases laid down by law, as state-delegated functions. Municipalities also organise 45 Public Health Bureaus, which are responsible for health promotion and prevention, population health monitoring, and planning and implementing local public health programmes (OECD, 2018[3]).
In terms of social care services, municipalities are responsible for the planning and provision of social services, the maintenance of their social care infrastructure and co-operation with non-governmental organisations (NGOs) (independent functions).
There is no single legislative framework nor common definition of LTC services in Lithuania. The MoH is responsible for health care, including geriatric services, nursing services and palliative care, while the MSSL is responsible for policies and legislation on social services and social workers (OECD, 2022[5]). Despite public recognition of the need to develop publicly provided home care, LTC remain predominantly provided in residential care institutions since municipalities lack financial and human resources to implement these services at home. Lithuania is reforming healthcare and social care services to reduce fragmentation and enhance service effectiveness, especially in LTC.
The funding of healthcare and social services in Lithuania
Healthcare services receive funding through compensations provided by the NHIF. The NHIF's financial resources primarily come from contributions made by the working-age population and central government. Other funding sources for healthcare include direct payments from patients, municipalities' own revenues, and transfers to municipalities from the central government. Municipalities fund PHC services once the NHIF reimbursement period has lapsed, such as after a patient exceeds the 120-day annual nursing care limit. It is crucial to understand that NHIF funding decisions can affect municipal services. For example, if the NHIF stops funding certain services like midwifery due to efficiency concerns, it could result in the closure of hospital units and patient transfers. Municipalities fund public and secondary healthcare services also with earmarked grants (state subsidies for delegated functions) from the Ministry of Health, as these are state-assigned functions. For home care services, the NHIF typically covers costs, excluding the integrated care project, which is financed by EU funds and the Ministry of Social Security and Labour (OECD, 2022[6]).
Social care services are funded by a combination of transfers from the central government, municipal own revenue and by user fees, the latter depending on patient’s income. Municipalities receive general purpose grants from the central government to fund general social services. They also receive earmarked state subsidies for delegated functions from the MSSL to fund social care for severely disabled adults.
The funding of LTC services is complex since it includes a mix of healthcare and social services. LTC funding comes various sources: the NHIF, earmarked state subsidies for delegated functions from the MoH for healthcare services, municipal budgets, earmarked state subsidies for delegated functions from MSSL and user fees for social care services. User fees for LTC social services are defined by municipalities. The large majority of LTC funding is allocated to inpatient healthcare compared to outpatient care in Lithuania (OECD, 2022[6]).
Source: Authors’ elaboration based on (OECD, 2018[3]; OECD/European Observatory on Health Systems and Policies, 2021[4]; OECD, 2022[6])
Unequal physical accessibility to PHC and LTC services in Tauragė+ functional zone
In Tauragė+ functional zone, despite a good public transportation network, the physical accessibility to primary and secondary healthcare services can be a challenge for patients due to geographical distances and fewer healthcare facilities.
Due to the above-mentioned challenges in PHC in Tauragė+ functional zone (i.e., shortage of specialist doctors and other medical staff, lack of investment in healthcare premises and modern equipment, as well as poor quality and low access to healthcare services), patients may also seek services from the private sector.
The physical accessibility of services in Tauragė+ functional zone, which depends mainly on travel time to the service units, is depicted in Figure 1.1. Both walking and driving distances are measured, showing that in public health care, the private PHC service provision complements accessibility, especially in Tauragė district municipality, whereas in the other three municipalities, the public health provision has at least as good or even better coverage than the private sector. As for the LTC, private sector provision has importance from physical accessibility perspective especially in Pagėgiai municipality and Šilalė district municipality. The maps also show that there are some specific areas in Tauragė+ functional zone which are not covered by either public or private health or LTC services. While it appears that in most of Tauragė+ functional zone, the health and LTC services can be accessed at least by 30-minute drive by car, this does not describe the situation for the people who must rely on public transportation. The driving times shown on the maps do, however, describe the potential for call taxi services2.
Note: Private PHC units (top left panel); public PHC units (top centre panel); public and private PHC units (top right panel); private LTC units (bottom left panel); public LTC units (bottom centre panel); public and private LTC units (bottom right panel). Grey colour represents areas where healthcare/LTC facilities are far from more than 30-minute drive. Using Mapbox API enabled us to use isochrones accounting for the road network and actual typical travel times instead of straight-line distance isochrones. Using isochrones, we identify the areas reachable from a facility within a set time frame for driving or walking. Overlaying these areas with the population grid gives an estimate of population access to these services. A limitation of these indicators is potential underestimation of travel time due to excluding public transport. Also, while it is possible for the Mapbox Isochrone API to return results that account for typical traffic congestion patterns at various times of day, the methodology of this project used the 'driving' profile of the API which uses only average traffic considerations and so may underestimate traffic congestion at particular times of day.
Source: OECD elaboration based on the Mapbox Isochrone API data and 2021 population data from (Statistics Lithuania, 2023[2]).
The share of population within specific travel durations to closest health and LTC facilities in Tauragė+ functional zone is provided in Annex D. It shows that in Tauragė+ functional zone, the proportion of the population residing in areas not more than a 30-minute drive to the nearest public health service unit varies between 96% to 98%, depending on municipality. Similarly, the population residing in areas not more than a 30-minute drive to the nearest LTC service unit varies between 88% to 95%, depending on municipality (Table 1.1). The table shows that physical accessibility for public and private health and LTC services seems best in Tauragė district municipality. While data does not include home care services3 due to unavailability, about 2.9% of older people receive social services at home and 6.2% receive at least one outpatient home nursing service in Lithuania, below OECD average of home care recipients (8.9%) (OECD, 2022[6]).
Note: Authors´ elaboration of the original data.
Source: Statistics Lithuania, Open Data, Gyventojų ir būstų surašymas 2021— Gyventojai (GRID 1km), https://open-data-ls-osp-sdg.hub.arcgis.com/datasets/80272a0f7a7e4905bc379f0ae921e5b7_1/explore?location=55.144279%2C23.902913%2C7.86., and Mapbox.
As part of the selected areas for co-operation within Tauragė+ functional zone, PHC and LTC have been selected to be piloted in partnership with the four municipalities, the MoH and MSSL. The piloting of these two services goes along with establishing enabling legal, institutional and fiscal frameworks for shared municipal services provision at the national level (Chapter 4). The recommendations and roadmaps presented in this section are based on the Finnish experience of shared municipal services provision (Chapter 3), data analysis, two missions carried out in Vilnius in November 2022 and Tauragė+ functional zone in February 2023 by the OECD and Finnish experts, as well as two working sessions in Tauragė+ functional zone in December 2023 and February 2024 with relevant municipal stakeholders in PHC and LTC.
5.2.1. Overview and starting points of the roadmaps
Roadmaps have been selected as a piloting tool to outline possible directions for shared services provision (IMC as a possible instrument) in order to improve availability, accessibility, affordability and acceptability of PHC and LTC services in the Tauragė+ functional zone (Box 1.2), as well as practical steps to pilot PHC and LTC in the functional zone.
In general, accessibility encompasses three fundamental aspects: availability, affordability, and physical accessibility (Thiede, Akweongo and McIntyre, 2007[7]; Campbell, Roland and Buetow, 2000[8]; Levesque, Harris and Russell, 2013[9]).
Availability of services refers to the presence and availability of LTC services within a given geographic area. It involves having an adequate number of care facilities, home care providers, and community-based services to meet the needs of the population.
Affordability covers the financial aspect of accessing LTC services. It involves the consideration of costs associated with care, including fees for residential facilities, in-home care services, medical equipment, medications, and related expenses. The affordability of LTC services is essential to ensure that individuals can access the care they need without facing excessive financial burden. It also consists of the public spending considerations on the municipal or central government side.
Physical accessibility refers to the ease with which individuals can physically reach and utilize LTC services. It involves factors such as geographical proximity of care facilities, transportation options, availability of specialized equipment, and accommodations for individuals with disabilities or mobility limitations. Ensuring accessibility enables individuals to access services conveniently and without barriers.
The roadmaps on PHC and LTC, presented in this section and developed for piloting, are in line with the views expressed by the municipal representatives and PHC and LTC practitioners of the Tauragė+ functional zone. The municipal representatives demonstrated interests in municipal shared services provision to improve the delivery of PHC and LTC services, to increasethe quality of the services, to use resources more efficiently (cost-effectively) and to provide better access to these services to citizens.
The two roadmaps are also in line with long-term national policy objectives, particularly in the health and social sectors where the Lithuanian government has started to plan a reform of municipal service provision.
More specifically, the roadmaps are based on:
The experts' views about the discussions hold with municipalities and ministries during the two OECD fact-finding missions and on-site visits (November 2022 and February 2023).
The results of the Logical Framework Analysis (LFA) group works in Pagėgiai and Tauragė (December 2023 and February 2024).
Data received from municipalities, the NHIF on PHC and LTC.
The relevant documents provided.
The experts´ knowledge and experience of shared municipal services provision in health and social services, especially in Finland.
Table 1.2 lists the suggested pilot actions and the main sources to elaborate them.
Note: Service housing is a housing unit which provides services according to the needs of the resident.
Source: Experts’ elaboration.
5.2.2. Recommended actions for piloting PHC and LTC in Tauragė+ functional zone
Pilot action for both PHC and LTC
Establishing reliable and timely database
Current situation: Data on services and functions is insufficient for planning, developing, managing, providing and evaluating PHC and LTC services according to the needs, efficiency and cost-effectiveness.
Objective: Improving and harmonising the database to be able to plan, manage and evaluate PHC and LTC services.
Activities:
1. Agree on the common minimum PHC and LTC dataset for the region.
2. Utilise the dataset for joint planning of services and cost-sharing.
A minimum dataset for planning/developing purposes is outlined in Annex A for PHC and LTC. A part of it is needed for the situation analysis, a part for annual or quarterly follow-up, and a part for impact evaluation.
For the management of services, detailed data is needed on services, such as human resources, visits, patients treated, hospital/service housing days, waiting lists, costs and financial data if services are shared between municipalities.
Recommended forms of shared services provision:
Joint development project by municipalities in official capacity
Please note that this activity is common to all objectives. It is therefore not repeated in the following pilot actions.
Recommended pilot actions for PHC
Pilot actions PHC 1: Ensuring a fair balance between primary and secondary healthcare
Current situation: High level of avoidable hospitalisation and unnecessary referrals to hospitals indicate inappropriate and inefficient use of healthcare resources.
Objective: Improving the balance between primary and secondary healthcare to reduce waiting time and shortage of PHC services in hospitals.
Activities:
1. Reduce unnecessary referrals to hospitals
2. Streamline service processes and provision
3. Develop mobile services (improved transport services and roving service-buses)
4. Reform service network (location of joint health stations)
5. Establish of a joint health centre (including several health stations)
Recommended forms of shared services provision:
Joint development projects
Contractual cooperation
Joint municipal authority and other options
Pilot actions PHC 2: Promoting adequate staff and appropriate staff structure
Current situation: Shortage of qualified staff, long waiting-times for PHC services.
Objective: Providing sufficient staff and appropriate staff structure to attract and retain qualified personnel in order to reduce waiting time for PHC.
Activities:
1. Improve sharing of health care resources (physicians, nurses), e.g. joint posts
2. Streamline service processes and provision
3. Re-evaluate incentives (monetary & other) and working conditions
Recommended forms of shared services provision:
Joint development projects in official capacity
Contractual cooperation
The most convenient solution to share resources would be to have four municipalities as one service area. This might be a long-term objective.
Municipalities can enter in contractual arrangements to provide PHC services to residents of the neighbouring municipalities. To be able to operate, accurate data on service costs must be available.
Pilot actions PHC 3 : Ensuring efficient PHC
Current situation: Moderate per capita costs combined with relatively high costs per patient underline the need for a more in-depth assessment of the functioning, organisation and performance (costs and outcomes) of PHC .
Objective: Improving performance and efficiency of PHC to better allocate and use available PHC services.
Activities:
1. Improve cross-border use of services
2. Improve sharing of health care resources (physicians, nurses) (e.g., joint planning and management of human resources)
3. Reduce unnecessary referrals to hospitals
4. Critically assess activities, service processes and performance to improve productivity and economic efficiency
5. Streamline service processes and provision
Recommended forms of shared services provision:
Joint development (i.e., municipalities can undertake joint development projects or programmes)
Inter-municipal evaluation (i.e., municipalities can compare/evaluate services in cooperation)
Contractual cooperation
Joint municipal authority
Pilot actions PHC 4: Establishing Integrated PHC Centres
Current situation: The need for PHC services is growing, but the provision of services is deemed insufficient. This is also reflected in the challenge of recruiting full-time qualified staff and long waiting lists.
Objective: Improving and providing more equal availability and accessibility of PHC services.
Activities:
1. Develop mobile services (improved transport services, minibuses touring municipalities in the region, bringing selected services to people living in remote areas)
2. Reform the service network (location of joint health stations)
3. Establish joint health stations
4. Establish a joint health centre (including several health stations)
Recommended forms of shared services provision:
Contractual cooperation
Joint municipal authority/company & other options
Pilot actions PHC 5: Improving the health and welfare promotion
Current situation: Treatable and avoidable mortality as well as avoidable hospitalisation are well above the national levels.
Objective: Improving the effectiveness and efficiency of health and welfare promotion to reduce treatable and avoidable mortality.
Activities:
1. Critically evaluate the effectiveness of existing health and welfare promotion activities and programs
2. Launch effective regional projects to promote health and well-being of the population
Recommended forms of shared services provision:
Shared municipal evaluation & projects
Joint committee
Pooling resources
Potential impact and timing of PHC pilot actions
Figure 1.2 shows an assessment of the impact of the proposed PHC pilot actions on the availability and accessibility of services, as well as the capacity to address urgency.
Source: Experts’ elaboration.
Recommended pilot actions for LTC
Pilot actions LTC 1: Improving staff and HR conditions
Current situation: Shortage of qualified staff, long waiting times, especially to home care and service housing4.
Objective: Improving competitive working conditions and salary pattern to attract and retain qualified personnel for LTC.
Activities:
1. Develop joint development programme on better working conditions
2. Delegate responsibilities to nurses
3. Strengthen teamwork
4. Organise training to become more competitive on recruiting and retaining qualified staff
Recommended forms and actions for shared services provision:
Joint development (i.e., municipalities can undertake joint development projects or programmes)
Avoid competition between municipalities in the region
The easiest solution to share resources would be to have four municipalities as one service area. However, this might be a long-term objective.
Municipalities can enter in contractual arrangements to provide home care and service housing services to residents of the neighbouring municipalities. To be able to operate, accurate data on services costs must be available.
Pilot actions LTC 2: Strengthening home care services
Current situation: Insufficient services, long waiting lists, fragmented service provision system.
There is a pilot to integrate health and social services in LTC in Tauragė+ functional zone.
A needs assessment rather than the estimation of the demand is crucial to utilise an agreed service package.
Objective: Improving home care service structures to reduce waiting lists and the shortage of LTC supply.
Activities:
1. Increase resources:
a. Municipal staff, resources sharing, opening the market for private/NGOs service providers.
b. Service voucher of defined euro values for home care services is a good practical tool.
2. Improve coordination between health and social services (e.g., one leadership, pooling resources).
3. Enable use of services across municipal borders, contractual cooperation.
4. “Hospital at home” (i.e., concept where nurses come to the patient’s home to do certain medical procedures which normally requires hospitalisation). This is cheaper than treatment in a hospital and more patient-friendly to get iv-drugs or special medications for severe pain of cancer patients. This service could be developed for the whole Tauragė area.
Recommended forms of shared services provision:
Municipality
Contractual cooperation
Joint provider unit covering health and social services within municipality and/or across municipalities
Pilot actions LTC 3: Ensuring a balanced care between hospitals and service housing
Current situation: 24/7 care is hospital-oriented and costly in social institutions.
Objective: Shifting to more service-housing-oriented system to rationalise costs related to social services.
Activities:
1. Analyse the population trends and service needs
2. Assess the hospital and service house network, scope and service network
3. Analyse and compare costs (i.e., hospital vs. service housing vs. home care vs. support to care takers; public vs. private)
4. Invest in service houses
5. Only in exceptional cases, it is practical, possible or cost-effective to try to modify old hospitals or other institutions to serve as modern and friendly service housing units/homes
Recommended forms of shared services provision:
Municipality
NGOs
Private companies
Joint municipal authority/company
Pilot actions LTC 4: Providing better access to day care centres
Current situation: The demand and supply of services is unbalanced.
Objective: Improving access to day care centres to better balance access to LTC.
Activities:
1. Enable use of services across municipal borders through contractual co-operation
2. Organise joint transportation services
Recommended forms of shared services provision:
Contractual co-operation and/or establishment of jointly operated facilities
Potential impact and timing of LTC pilot actions
Figure 1.3 shows an assessment of the impact of the proposed LTC pilot actions on the availability and accessibility of services, as well as the capacity to address urgency.
Source: Experts’ elaboration.
Next steps in implementing pilot projects for PHC and LTC the Tauragė+ functional zone
The recommended pilot actions can be implemented in a variety of ways. Possible timetable is described in Figure 1.4 based on experts’ experience in Finland.
It is assumed that municipalities have set up the appropriate co-ordination mechanisms and bodies to lead the pilot projects and that they have defined clear roles and responsibilities for the different stakeholders involved, as well as the principles of decision-making and financing.
PHASE I: Validating the database to support informed decision-making
1. Consolidating the database, reassessing the baseline and anticipating service needs by year 2030.
PHASE II: Defining key elements on projects to be implemented
1. Reassessing and confirming the project objectives (general, PHC and LTC specific objectives).
2. Selecting and deciding the projects to be implemented in PHC and LTC.
3. Defining the targeted state of services provision (including the range of services, principles of services network) and service mix for PHC and LTC in year 2030.
PHASE III: Determining the governance model and funding
1. Defining the governance model (e.g., contractual co-operation, joint municipal authority)
2. Choosing the most appropriate funding model (e.g., principles of cost sharing between municipalities)
PHASE IV: Consulting stakeholders and making decisions
1. Consulting relevant stakeholders on proposed pilot actions
2. Deciding (by municipalities) on the implementation of co-operation
3. Deciding on the funding model between municipalities (i.e., principles of cost-sharing between municipalities)
PHASE V: Implementing
1. Establishing a body for shared municipal services provision
2. Implementing the recommended pilot actions
3. Monitoring impact evaluation
Source: Experts’ elaboration.
The implementation of some of the above recommended pilots may also require adjustments in legislation and in funding and financing system of health and LTC services at national level (Chapter 4).
Figure 1.5 illustrates the challenges that need to be addressed when shared services provision takes the form of a joint municipal authority. The challenges for other forms of cooperation are more limited, although the main ones can be found in the figure.
Source: Experts’ elaboration based on Integrated Health and Social Services in North-Karelia (Finland).
The recommended pilot actions for PHC and LTC are based on the Finnish experience on shared municipal services provision and a diagnosis of the current demand, supply, challenges and strengths of these two services within Tauragė+ functional zone at the time of writing. Local conditions and needs, as well as national frameworks can evolve, which would require to adjust pilot actions with the new situation. The implementation process must therefore be flexible and adaptable to changing environment and priorities. The lessons learned and progress done with the pilots in PHC and LTC in Tauragė+ functional zone could also, in turn, inform the recommendations and action plan described in Chapter 4 to further enable legal, institutional and fiscal frameworks for shared municipal services provision at the national level.
References
[8] Campbell, S., M. Roland and S. Buetow (2000), “Defining quality of care”, Social Science & Medicine, Vol. 51/11, pp. 1611-1625, https://doi.org/10.1016/S0277-9536(00)00057-5.
[10] Campbell, T. and H. Fuhr (2004), Leadership and Innovation in Subnational Government Case Studies from Latin America.
[9] Levesque, J., M. Harris and G. Russell (2013), “Patient-centred access to health care: Conceptualising access at the interface of health systems and populations”, International Journal for Equity in Health, Vol. 12/1, pp. 1-9, https://doi.org/10.1186/1475-9276-12-18/FIGURES/2.
[5] OECD (2022), “Improving long-term care policy in Lithuania”, in Integrating Services for Older People in Lithuania, OECD Publishing, Paris, https://doi.org/10.1787/2c84ba72-en.
[6] OECD (2022), Integrating Services for Older People in Lithuania, OECD Publishing, Paris, https://doi.org/10.1787/c74c44be-en.
[3] OECD (2018), OECD Reviews of Health Systems: Lithuania 2018, OECD Reviews of Health Systems, OECD Publishing, Paris, https://doi.org/10.1787/9789264300873-en.
[4] OECD/European Observatory on Health Systems and Policies (2021), Lithuania: Country Health Profile 2021, State of Health in the EU, OECD Publishing, Paris, https://doi.org/10.1787/20b64b36-en.
[2] Statistics Lithuania (2023), Home - Oficialiosios statistikos portalas, https://osp.stat.gov.lt/en (accessed on 12 July 2023).
[1] Tauragė district municipality, J. (2023), “Taurage+ functional area strategy 2023-2029”.
[7] Thiede, M., P. Akweongo and D. McIntyre (2007), “Exploring the dimensions of access”, in McIntyre, D. and G. Mooney (eds.), The Economics of Health Equity.
← 1. The Development Strategy for the Tauragė+ functional zone was approved by the Tauragė district municipal Council Decision No 1-99 of 25 March 2020, the Jurbarkas district municipal Council Decision No T2-66 of 26 March 2020, the Šilalė district municipal Council Decision No T1-100 of 3 April 2020 and the Pagėgiai municipal Council Decision No T-51 of 23 April 2020. The Strategy shall be implemented in accordance with commonly formulated priorities through action planning not limited to municipal administrative boundaries. In 2021, by municipal decision, the Public Enterprise "Green Region" was established to coordinate joint actions (Tauragė district municipality, 2023[1]).
← 2. The Mapbox Isochrone API provides isochrone polygons from a facility using its geographical coordinates as inputs for time ranges up to 60 minutes for three modes of transport: driving, cycling and walking, see https://docs.mapbox.com/api/navigation/isochrone/. Access to the Mapbox API was granted through the Development Data Partnership (https://datapartnership.org/).
← 3. Since 2013, integrated home care is provided by a team of social services and personal health care professionals (i.e., a social worker and his/her assistants, a nurse and his/her assistants, and a rehabilitation specialist), whose aim is to identify a person’s need for social care and home care services, to organise and provide appropriate services (OECD, 2022[6]).
← 4. Service housing is a housing unit which provides services according to the needs of the resident.