Referral in hand, still a long wait: what Latvia's e-referrals change and what is coming next

Patients in Latvia who receive a referral to a specialist from their family doctor still often face waits of several months for a state-funded visit, while a paid consultation is frequently available sooner. The health system is trying to ease this with electronic referrals (e-referrals) and an upcoming unified e-booking tool. Representatives of the National Health Service and the Latvian Digital Health Centre discussed the changes in the magazine "Par Veselību".

Why queues are long

Commonly cited reasons are insufficient state funding and a shortage of certain specialists, so there are fewer state-funded services than patients need. The source stresses, however, that this is not the whole picture. Waiting times are also shaped by the volume of state-funded services, the order of referrals and priorities, the separate booking systems of individual medical institutions, and how much of the process is coordinated by the health system versus the patient.

Previously, a patient with a paper referral could sign up at several institutions, because there was no data on where it had already been used. This created artificial queues.

What e-referrals changed

The new-format e-referrals went into use on 20 November last year, each with a unique ID number. The transition period ended on 4 May this year, so from 5 May only electronic referrals may be used. When making a booking, a medical institution attaches the referral to itself, so the same referral cannot be used to book an equivalent service elsewhere. If a booking is cancelled, the referral returns to "Active" status in the e-health system. Zane Gorškova, communications head at the Latvian Digital Health Centre, calls this the "one e-referral – one appointment" principle.

Urgent referrals, for example those marked CITO!, are processed in priority order, and the institution contacts the patient to offer the earliest possible time.

Unified e-booking

The principle will fully work once unified e-booking is introduced on the portal www.eveseliba.gov.lv. There, residents will be able to see all available appointment times, book, and link the booking to their e-referral. Medical institutions had to adapt their systems by 1 October. The new resident portal is in the final stage of development, with only security testing left before it is opened to the public.