📄 Įstatymo tekstas
LAW
LAW
of the Republic of Lithuania
AMENDING THE
LAW ON THE HEALTH SYSTEM
1 December 1998 No.VIII-946
Vilnius
Article 1. Revised Version of the Law on the Health System of the Republic
of Lithuania
“REPUBLIC OF LITHUANIA
LAW ON THE HEALTH SYSTEM
The Seimas of the Republic of Lithuania,
recognising, that
the health of the population is the greatest social and economic asset of the society,
health means not only the absence of diseases and physical defects, but also people’s physical, mental and social welfare,
health potential and its maintenance conditions are dependent on the stability of the economic system development, the society’s social security and education guarantees, employment and adequate income of the population, provision with housing, accessible, acceptable and adequate health care, proper nutrition, adequate quality of work, living and natural environment, as well as on the efforts of the population to promote health,
a person’s efforts to stay healthy may only be spurred by social and economic measures which are acceptable from the point of view of the present time and human dignity,
the best possible state of health of the population is a necessary prerequisite of security and prosperity of the State of Lithuania as well as a sine qua non for the creation of an open, just and harmonious civic society;
taking into consideration the provisions of the strategy “Health for All”, adopted by the World Health Organisation, the Ottawa Health Promotion Charter and the National Health Concept of Lithuania;
seeking to safeguard the in-born human right to enjoy the best possible state of health as well as the right to a healthy environment and acceptable, accessible and adequate health care;
guided by the Constitution of the Republic of Lithuania,
enacts this Law on the Health System.
Part I
THE HEALTH SYSTEM
Chapter I
GENERAL PROVISIONS
Article 1. The Purpose of the Law on the Health System
The Law on the Health System shall regulate the national health system of Lithuania, its structure, the scope of legal regulation of health protection, health strengthening and health recovery, the basic principles of individual and public health care organisation, of ensuring, management of the health care guaranteed by the state or local authorities (free health care), of health support, conclusion of contracts concerning health activities, also the liability for infringement of health activities regulations and the rights and duties of the population and the health activities bodies.
Article 2. Definitions
As used in this Law:
1. Health means physical, mental and social welfare of the individual and society.
2. Public health protection means the totality of organisational, technical, social, economic and legal measures intended to protect the health of the society or its individual groups from harmful effect of the environmental factors or to reduce the risks thereof to the minimum.
3. Strengthening of public health means organisational, legal, social and economic measures implemented by state institutions, executive institutions of municipalities, other legal and natural persons, contributing to the augmentation and rational use of health care resources, formation of the social control system of public health problems settlement, encouraging the public to take part in the formation of state and municipal health policy, helping to create a healthy environment, promoting a healthy life style and increasing the effectiveness of motivation in espousing it, spurring health insurance organisations and individual health care institutions to opt for health measures with greater economic efficiency, based on disease prevention.
4. National Health System of Lithuania means the system of management of state health affairs, health institutions, health activities and relating resources.
5. Health activities means individual health care, public health care, pharmaceutical and other health activities, the types and requirements whereof to the bodies performing the activities shall be established by the Ministry of Health Care.
6. Individual health care means the activities of natural and legal persons licensed by the state, the purpose whereof is to timely diagnose and prevent the individual’s health disorders, also to help recover and strengthen health.
7. Public health care means the aggregate of organisational, legal, economic, technical, social and medical measures which help implement disease and trauma prevention, preserve public health and strengthen it.
8. Pharmaceutical activities means the activities of natural and legal persons, regulated under the Law on Pharmaceutical Activities.
9. Acceptability of health care means the conditions of health care recognised according to the procedure established by the state, which ensure the conformity of health care services with the principles of medical science and medical ethics.
10. Accessibility of health care means the conditions of health care recognised according to the procedure established by the state, which ensure economic, communicative and organisational acceptability of health care services to the individual and society.
11. Adequacy of health care means the conditions of health care recognised according to the procedure established by the state, which guarantee the quality and effectiveness of health care services.
12. Individual health care guaranteed by the state (free individual health care) means individual health care services financed from the compulsory health insurance fund, state or municipal budgets, state or municipal health funds.
13. Medical audit means expert examination and control of accessibility, economic efficiency and adequacy of health care services.
14. Local medical audit means medical audit arranged or ordered by health care institutions.
15. State control of public health means official actions performed by state inspectorates, state offices and services, other institutions authorised by the state, their officers for the purpose of:
1) supervising compliance with legal acts regulating public health protection by enterprises and institutions, other legal and natural persons and applying sanctions prescribed by law for their violations (direct state control of public health);
2) achieving, by means of negotiations or contracts, that enterprises and institutions, other legal persons commit themselves to improving the state of public health care (support of public health care);
3) collecting, storing, processing and analysing, within the limits of competence, information relating to the violations of legal acts regulating public health protection, the social, economic and other causes of the violations as well as all other factors affecting the state of public health protection (indirect public health control).
16. Public health monitoring means the system of monitoring of public health factors, developments, effects of the factors upon public health, also of public health resources and public health care processes and results (recording, storing and processing of data).
17. Expert examination of public health means the process of establishment of potential or actual effect upon public health of public health factors and preparation of findings and proposals on the prevention or limitation of the effect.
Article 3. The Scope of Legal Regulation of Health Relations
The following shall only be established by laws:
1) the sphere, tasks and principles of the effectiveness of health law;
2) the system of types and bodies of health activities, the competence of the main bodies of health activities management, rights and duties in the sphere of pharmaceutical activities of state services and state inspectorates of health activities co-ordination and health care, also of institutions of individual and public health care and bodies of pharmaceutical activities, the legal framework for their establishment, activities and termination thereof;
3) the legal framework of establishment, activities, reorganisation of the state inspectorates of public health control subordinate to the Ministry of Health Care, the conditions and procedure of state control of public health;
4) the structure of resources of the national health system and basic principles of their management;
5) the basic principles of health activities organisation and management and of health support and financing;
6) the necessary conditions of health activities and the legal framework of their control;
7) the rights and duties of the population in health activities, the basic legal principles of participation of the population in the management of health matters;
8) the basic legal principles of licensing for health activities the persons who have higher or special secondary medical or other education, basic professional rights and duties of medical specialists, the procedure for establishing the qualifications requirements, for their in-service training and the restriction of their practice, the legal framework of the restriction of health care advertising, of the establishment of third party liability for the damage done to the patients’ health in the course of implementing individual health care;
9) the procedure for entering into health activities contracts and basic terms and conditions thereof;
10) the system of public health care, the procedure of its organisation, management and financing as well as for implementing public health care;
11) the legal framework of the organisation and management of safety at work and occupational medicine, also of consumer health protection;
12) the general requirements for the quality of food products. The procedure of control over the conditions of manufacture, importation, trading in, advertising of such products, control over the quality of food products and their containers, also of marking said containers;
13) the general requirements for the quality of drinking water, basic legal principles of water treatment, decontamination, and quality improvement;
14) the procedure for controlling the production, trade, import, export, licensing and consumption of narcotic and psychotropic substances and their precursors, alcohol products, tobacco and its products, the system of reducing the consumption of alcoholic beverages and tobacco products, the procedure for restricting or prohibiting the advertising of alcoholic beverages and tobacco products;
15) the conditions of production, trade in, import, export, transportation, use of poisons, other toxic and radioactive substances, requirements for working with ionising radiation sources, conditions for ensuring radiation safety and the procedure of their control;
16) the system of prevention of communicable diseases, legal framework of organisation and management of the prevention and control of said diseases;
17) the conditions of public health monitoring, expert examination of public health, legal framework of organisation and management thereof;
18) the basic legal principles of the organisation and management of physical education and sport, of dope and gender control;
19) the conditions of mental health care, the basic legal principles of the organisation and management thereof as well as the legal framework of control over the conditions of care;
20) the basic legal principles of the organisation of medical and social rehabilitation of the disabled;
21) the conditions of dental care and substance dependence supervision and the legal framework of organisation and management thereof;
22) the requirements of biomedical tests ethics, the procedure of control over compliance with said requirements as well as liability for violations of requirements of biomedical tests ethics;
23) the conditions and procedure for taking blood from donors, production of blood products, transfusion of human blood and its products;
24) the basic principles, conditions and procedure for taking organs or tissues for transplants, their use for transplants, medical research, diagnostics, and treatment;
25) the criteria of the establishment of terminal conditions and the fact of death of an individual, conditions of an individual’s refusal from all or part of life prolongation services, conditions and procedure for post-mortem examination (autopsy) of the cadaver;
26) the legal framework of organisation and management of pharmaceutical activities;
27) the procedure for the registration of drugs and their quality control;
28) the health insurance system, the procedure for collecting compulsory health funds, legal framework of voluntary health insurance, rights and duties of the covered persons, the policy holders and the insurers, the procedure for establishing health insurance institutions and their activities as well as rights and duties of these institutions; and
29) basic principles of liability for violations of the requirements of laws on health activities.
Article 4. The Purposes of Health Activities
The purposes of health activities shall be as follows:
1) to reduce the falling behind of certain social and professional groups of society from other groups of society as shown by the health condition indicators, without worsening the population’s general level of health;
2) to protect the population against diseases, avoidable death or invalidity;
3) to extend the length of life without diseases and traumas, and improve its quality;
4) to increase economic and social efficiency of life.
Article 5. Principles of Health Activities Regulation
The following principles shall be applied to the regulation of the relations specified in Articles 1 and 3 of this Law:
1) extensive protection of individual and public health;
2) co-ordination of individual, public health and state interests;
3) equality of the individual’s rights to have the best possible health regardless of his or her sex, race, nationality, citizenship, social status and profession;
4) the individual’s freedom to chose the best possible health conditions;
5) acceptability, accessibility and adequacy of the individual health care;
6) the freedom of individuals to unite into public organisations defending the interests of the individual and public health, as well as state support for the programmes of activities of these organisations;
7) comprehensive, accurate and timely notification of the public of the best possible conditions of health development and the advertising of said conditions;
8) participation of public organisations in the health activities management both directly and through their elected representatives;
9) state support for persons in protecting, recovering and improving their health;
10) establishment of health care guaranteed by the state(free health care);
11) full prevention against threat and damage to individual and public health carried out by all bodies of health activities; and
12) healthful economic activities and initiative promoted by the state.
2. If the relations specified in Articles 1 and 3 of this Law are not regulated by laws and provisions of legal norms which regulate similar relations cannot be applied thereto, the principles set forth in paragraph 1 hereof shall be applied in the settlement of any disputes that may arise.
Chapter II
NATIONAL HEALTH SYSTEM OF LITHUANIA
Article 6. Basic Principles of Formation of the National Health System
of Lithuania
The basic principles of formation of the National Health System of Lithuania shall be as follows:
1) general management of health affairs in the Republic of Lithuania;
2) ensuring social justice in health activities;
3) integration of all health activities resources into the unified system, their planning and use according to the national priorities of health activities;
4) integration of individual health care and public health care into a general system;
5) ensuring the implementation of the Health Programme of Lithuania as well as of the state and municipal health programmes;
6) ensuring the interdepartmental co-ordination of health activities;
7) ensuring the participation of the public in the shaping of health policy.
Article 7. The Structure of the National Health System of Lithuania
The National Health System of Lithuania (hereinafter referred to as the NHSL) shall consist of:
1) the executive bodies of the NHSL;
2) the administrative bodies of the NHSL;
3) the resources of the NHSL;
4) the activities and the range of services supplied by the NHSL.
Article 8. The Executive Bodies of the NHSL
The executive bodies of the NHSL shall be the following institutions possessing licences for health care or pharmaceutical activities:
1) state and municipal individual and public health care budgetary and public institutions;
2) state and municipal enterprises;
3) other enterprises and institutions which have concluded contracts with the state or territorial patients’ funds or other contractors for the NHSL services - for the term of validity of the contracts.
Article 9. The Administrative Bodies of Health Activities
1. The administrative bodies of health activities shall be:
1) bodies of state administration of health activities (the Government, ministries, other Government institutions, county governors);
2) institutions co-ordinating the health activities;
3) special health activities management and control bodies;
4) executive institutions of municipalities.
2. The administrative bodies of health activities shall within the limits of their competence supervise, according to the procedure established by this Law, other laws and legal acts, the activities of other executive bodies of health activities which do not belong to the NHSL.
Article 10. The Resources of the NHSL
The NHSL resources shall comprise:
1) material resources intended for ensuring the NHSL management;
2) the property of the executive and administrative bodies of the NHSL;
3) state and municipal budget resources allocated for the purpose of ensuring the NHSL activities;
4) compulsory health insurance funds;
5) any other property, assigned by laws for the purpose of ensuring the NHSL activities;
6) specialists and other employees of state and municipal institutions, enterprises, possessing licences for individual and public health care, pharmaceutical activities;
7) databases of information concerning individual and public health.
2. The NHSL resources shall be regulated by this Law and other laws and legal acts.
3. Execution may not be levied against the property and funds of health care institutions maintained from the State budget.
Article 11. Activities and Services of the Executive Bodies of the NHSL
1. The activities of and services supplied by the NHSL shall comprise:
1) individual health care;
2) public health care;
3) pharmaceutical activities;
4) other (paid) services supplied by the executive bodies of the NHSL, which are not attributed to health care and pharmaceutical services but are necessary in order to ensure the provision thereof. Charges for the services shall be fixed by the administration of the institutions providing the services.
2. The executive bodies of the NHSL shall provide, according to their respective competence, health care services of the following types:
1) individual and public health care services not paid for directly to the health care institutions by their recipients but financed from the compulsory health insurance fund, state or municipal budgets or health funds;
2) paid individual and public health care services which must be paid for by their recipients (legal and natural persons). The list of such services, their prices, the procedure for price indexing and service provision shall be approved by the Ministry of Health Care.
Article 12. Health Care and NHSL Activities Organisation Levels
1. The levels of the NHSL activities organisation shall be:
1) municipal;
2) county; and
3) national.
2. The health care levels shall be:
1) primary (primary health care);
2) secondary (secondary health care); and
3) tertiary (tertiary health care).
3. Local authority executive institutions shall organise primary individual and public health care. The procedure for organising primary health care shall be laid down by the Government or the institution authorised by it.
4. Local authority executive institutions shall also fulfil the function of the state delegated by law - shall organise secondary health care the scope and profiles whereof shall be determined by the Ministry of Health Care.
5. County governors shall organise secondary individual and public health care the scope and profiles whereof shall be determined by the Ministry of Health Care.
6. The Ministry of Health Care and state institutions subordinate to it shall organise, according to their respective competence, individual and public health care of the prescribed scope within the NHSL institutions subordinate to it. In the health care institutions whose founders are the Ministry of National Defence or the Ministry of the Interior, the individual health care of the prescribed scope shall be organised accordingly by the Ministry of National Defence, the Ministry of the Interior or state institutions subordinate to them.
7. The institutions of the tertiary level of the NHSL health care organisation may practise primary and secondary health care only for scientific and educational purposes.
8. The scope of health care according to the levels of the NHSL activities organisation and the health care levels shall be established by the Ministry of Health Care.
Article 13. Contractors of the NHSL Activities and of the Services Provided
by the Executive Bodies of the NHSL
1. The contractors of the NHSL activities and provided services shall be the Government, the Ministry of Health Care, other state institutions, county governors, municipal councils, State and Territorial Patients’ Funds and other institutions disposing of the NHSL resources.
2. Other legal and natural persons or enterprises without the rights of the legal person may also be contractors of other activities carried out and services provided by the NHSL executive bodies.
PART TWO
HEALTH ACTIVITIES
Chapter II
GENERAL PROVISIONS
Article 14. The Contents of Health Activities
Health activities shall comprise:
1) individual health care;
2) public health care;
3) pharmaceutical activities; and
4) other health activities, the types and requirements whereof for the entities carrying out the activities shall be established by the Ministry of Health Care.
Article 15. Mandatory Conditions of Health Activities
1. The mandatory conditions of health activities in the Republic of Lithuania shall be:
1) acquisition of the right to practise certain types of health activities;
2) accessibility, acceptability and adequacy of individual and public health care;
3) the individual’s consent to be provided with health care services, except in cases stipulated in laws when such services may be provided without his consent.
2. Health activities shall cover only the territory of the Republic of Lithuania, unless otherwise provided for by international agreements to which the Republic of Lithuania is a party.
3. The mandatory conditions of health activities must be ensured by all entities of health activities.
Article 16. The Right to Engage in Health Activities
1. The right to engage in a certain type of health care practice shall be recognised to natural persons who have been issued, in the manner prescribed by law, a licence and a certificate. The right to engage in a certain type of pharmaceutical practice shall be recognised with respect to natural persons who have received a permit in the manner prescribed by law.
2. Enterprises and institutions shall acquire the right to engage in health care activities only upon receiving the licences according to the procedure prescribed by the Government or the institution authorised by it.
3. Enterprises, institutions and organisations shall acquire the right to engage in pharmaceutical activities only upon receiving licenses in the manner prescribed by the Government or the institution authorised by it. The pharmaceutical activities shall be carried out in compliance with the Law on Pharmaceutical Activities, other laws and legal acts.
4. Enterprises and institutions may be accredited for health care.
5. Health care or pharmaceutical activities carried out by natural persons, enterprises or institutions who are not in the possession of a licence or permit shall be illegal.
6. The right to engage in other health activities the types and requirements whereof for the entities engaged in the activities shall be established by the Ministry of Health Care shall be recognised only for the enterprises and institutions which have on their staff physicians or other health care specialists who have acquired the right to the activities according to the procedure prescribed by this Law and other laws. Natural persons who are not health care specialists or do not meet the requirements laid down by the Ministry of Health Care shall have no right to engage in health activities.
Chapter II
INDIVIDUAL HEALTH CARE
Article 17. The Contents of Preventive Medical Aid
Preventive medical aid shall comprise:
1) information services on issues of disease prevention, which must be provided by all individual health care specialists;
2) (selective) health examination of separate groups of individuals;
3) immuno-prophylaxis and chemical prophylaxis of communicable diseases;
4) prophylactic examinations.
Article 18. Prophylactic Examinations
1. Workers of certain professions and individuals working in certain jobs, production branches and sectors must undergo a health examination before taking up professional activity and in the course of such activity. The list of the above professions, jobs, production branches and sectors and the procedure of examination of individuals’ health shall be established by the Government or the institution authorised by it.
2. Health care institutions must within the established time period examine the health of pregnant women and children under 16 years of age, also the health of mothers until the infant reaches the age of one and of other persons whose list shall be compiled by the Ministry of Health Care.
3. The procedure and terms and conditions of examination, isolation, and keeping the individuals under observation for possible communicable disease shall be established by the Law on Human Communicable Disease Prevention and Control.
Article 19. Basic Medical Aid
The following shall be attributed to basic medical aid:
1) first medical aid;
2) institutional (out-patient or in-patient) emergency medical aid.
2. The scope of basic medical aid and the procedure of provision thereof shall be established by the Ministry of Health Care.
3. When rescuing the lives of individuals who must be rendered medical aid following an accident, mishaps, ecological or natural disasters, or a sudden onset of illness, first medical aid must be promptly rendered by the health care, pharmaceutical specialists and other persons, who are with the victims or patients at the site of an accident or during the onset of an acute and life-threatening illness. The list and sphere of competence of health care, pharmaceutical specialists and other persons who must render first medical aid shall be established by the Ministry of Health Care.
Article 20. Peculiarities of Application of Diagnostic and Treatment Measures
1. Health care specialists shall have the right to choose methods and technologies of diagnostics and treatment approved in the manner established by the Ministry of Health Care.
2. Health care specialists may use all scientifically substantiated, but not yet registered in the prescribed manner medicines, preventive, diagnostic and treatment methods, medical equipment and instruments only when trying to cure the patient and to save or prolong his life. In this instance, they must obtain the patient’s permission, and if the patient is unconscious or is a minor - the permission of his parents, relatives, guardians, or his representative and also the consent of the ethics commission of the health care institution. This consent must be confirmed in writing. When the patient is in an unconscious state and there is no information available regarding his relatives, parents, guardians or representatives, these technologies shall only be applied upon written consent of at least two physicians of the appropriate medical speciality in consultation as well as that of the ethics commission of the health care institution.
3. The application of compulsory hospitalisation, compulsory diagnostic, and compulsory treatment measures to individuals shall only be allowed on the grounds and in the manner provided for by law in the presence of a genuine threat that these individuals by their actions or because of the state of their health may cause substantial damage to their own health or life or to that of other persons.
Article 21. Transfusions of Human Blood and its Products
Human blood may be taken from a donor for transfusion purposes or for the purpose of production of blood products only of the donor’s free will and with the latter’s consent. The relations connected with the taking of human blood and production, export, import and transfusion of blood products shall be regulated by the Law on Blood Donorship.
Article 22. Restrictions on the Use of Human Tissues and Organs
1. Human tissues or organs may not be objects of commercial transactions.
2. Conditions and procedure of the use of human tissues and organs taken from a human body and the rights of tissue or organ donors shall be established by the Law on the Donorship and Transplantation of Human Tissues and Organs.
Article 23. Medical Rehabilitation and Treatment in Sanatoria
The conditions and procedure for selecting and sending patients to health care institutions of medical rehabilitation and sanatoria-type health care institutions shall be established by the Ministry of Health Care.
Article 24. Nursing of Patients
1. Nursing services shall be provided to the patients at home, in health care institutions and in social care institutions.
2. The procedure for providing nursing services to patients shall be regulated by laws and other legal acts.
Article 25. Social Services Provided while Carrying out Individual Health Care
1. Provision of social services when carrying out individual health care shall be organised in order to guarantee social security of the patients, children and elderly people, disabled individuals, other individuals belonging to risk groups, to ensure their mental health care and psychosocial rehabilitation. Social services shall be provided by social workers of individual health care institutions.
2. The procedure for providing social services at health care institutions shall be regulated by laws and other legal acts.
3. The regulations of work at health care institutions of social workers employed at health care institutions shall be approved, the procedure of their training and in-service training shall be established by the Ministry of Social Security and Labour in conjunction with the Ministry of Health Care.
Article 26. Expert Examination of Temporary Disability
1. The expert examination of temporary disability shall be performed by the health care institution physicians or a consultative commission of physicians. The procedure for organising and performing the expert examination shall be established by the Ministry of Health Care and the Ministry of Social Security and Labour.
2. The procedure for performing the expert examination of temporary disability of servicemen shall be established by the Ministry of National Defence on co-ordination with the Ministry of Health Care.
Article 27. Medical Social and Specialised Medical Expert Examination
1. In cases of long-term or permanent loss of ability to work medical social expert examination shall be performed in the manner prescribed by the Ministry of Health Care and Ministry of Social Security and Labour.
2. The procedure for organising and performing the specialised medical expert examination within the scope of their respective competence shall be established by the Ministry of Health Care or Ministry of the Interior or Ministry of National Defence on co-ordination with the Ministry of Health Care.
Article 28. Forensic Medical Expert Examination
Forensic medical expert examination shall be performed on the decision of inquiry or investigation bodies, also following the court ruling. The executive bodies of the expert examination, its organisation and performance procedure shall be established by the Government or the institution authorised by it.
Article 29. Forensic Psychiatric Expert Examination, Forensic Expert
Examination of Substance Dependence and Forensic Psychological
Expert Examination
Forensic psychiatric expert examination, forensic expert examination of substance dependence and forensic psychological expert examination shall be performed on the decision of the bodies of inquiry or investigation or the prosecutor, also following the court ruling. The expert examinations shall be performed by the State Forensic Psychiatric and Substance Dependence Service under the Ministry of Health Care and health care institutions subordinate to it. The procedure for organising and performing the expert examinations shall be established by the Government or the institution authorised by it.
Article 30. Pathoanatomical Expert Examination
Pathoanatomical expert examination shall be performed in the event of a person’s death. The conditions and procedure of pathoanatomical examination (autopsy) shall be regulated by the Law on Health Care Institutions and other legal acts.
Chapter III
PUBLIC HEALTH CARE
Article 31. Universal Character of Public Health Care
Implementation of public health care the purpose whereof is health promotion, prevention of the deterioration of the quality of consumer goods, food products, drinking water, also of living, working and natural environment as well as prevention of diseases and traumas and decrease of morbidity shall be the duty of all natural and legal persons.
Article 32. Promotion and Strengthening of Public Health
1. The conditions and procedure of public health promotion shall be established by this Law and other laws. The promotion of public health shall consist of:
1) health propaganda in the media;
2) popularisation of health-related knowledge;
3) health education;
4) family planning consultations.
2. The Ministry of Health Care, other governmental institutions, county governors, executive bodies of local authority shall organise with state and local budget funds, according to their respective competence, health propaganda in support of health policy initiatives over the radio and television as well as other media.
3. Health education shall be the aggregate of voluntary and compulsory health and physical education measures.
4. The contents of public health strengthening shall be established by laws and other legal acts.
Article 33. Protection of Public Health
1. Public health protection shall be based on a system of measures limiting harm and danger in living, working and natural environment.
2. Prevention and limitation of danger and harm to health shall be implemented in the manner prescribed by laws and other legal acts:
1) the indicators of safety and harmlessness to health as well as the hygiene requirements of the working, living and natural environment, food products and drinking water, raw materials, machinery and equipment, other goods, economic or other activity shall be regulated;.
2) economic - commercial activities shall be subject to licensing;
3) individual and public health care activities of legal and natural persons, enterprises without the rights of the legal person shall be subject to licensing;
4) sanitary protection zones shall be established;
5) quotas for the production of goods detrimental to health shall be fixed;
6) public health protection expert examination shall be carried out;
7) economic - commercial or other activity detrimental or dangerous to health shall be suspended;
8) goods harmful to health, which have been listed in the Law on Excise Duties shall be subjected to individual excise duties and other economic regulation measures prescribed by law;
9) violation of legal acts on health activities shall incur liability under law.
3. Raw materials, machinery, equipment, building materials, elements of the interiors of housing, food and its packaging, containers, other goods, drinking water must not carry a risk to health, or else this risk may only be minimal. The Ministry of Health Care shall lay down the requirements of safety and harmlessness to health of working, living and natural environment, economic or other activities, consumer goods.
4. Enterprises and persons who are engaged in the economic-commercial activities put on the list drawn up by the Ministry of Health Care must be in possession of a permit - hygiene certificate.
5. The procedure for issuing permits - hygiene certificates and grounds for refusing the issuance thereof shall be laid down by the Ministry of Health Care. Permits - hygiene certificates shall be issued by the state public health care institutions authorised by the Ministry of Health Care, also by the enterprises entitled under law to perform expert examination of public health protection.
6. Public health control institutions shall have the right to ban, suspend or limit, according to the procedure and on the grounds specified by law, economic - commercial activities, import of goods, their sale, supply of services.
Article 34. Disease Prevention and Control
1. The basic principles and procedure of communicable disease prevention and control shall be established by the Law on Human Communicable Disease Prevention and Control.
2. Health care institutions, other enterprises and institutions must organise, according to their respective competence, prevention of non-infectious diseases and traumas.
3. The procedure of non-infectious disease prevention and control shall be established by the Ministry of Health Care.
4. The measures preventing traumatism conditioned by transport and their contents shall be specified, according to their respective competence, by the Ministries of Health Care, Transport, the Interior and other.
5. The procedure of preventing occupational diseases and accidents at work shall be established by the Law on Labour Protection and other legal acts.
Article 35. Public Health Emergencies
1. Public health emergency shall be a situation where the environmental factors condition a sudden:
1) danger of health damage on the group or mass scale;
2) occurrence of cases of the population health damage on the group or mass scale.
2. The territory where the danger of damage to public health on the group or mass scale suddenly arises shall be declared on the Government’s resolution an area dangerous to public health.
3. The territory where damage is caused to population groups or a large section of the population shall be declared on the Government’s resolution an area detrimental to public health.
4. The criteria for determining public health emergencies, the measures of public health emergency situations management, control, measures for the elimination of adverse negative effects to public health and economy and their financings shall be approved by the Government or the institution authorised by it.
Article 36. Public Health Monitoring and Expert Examination
1. Access to the information on public health may not be restricted and the information may not be considered as state or commercial secret.
2. Public health monitoring shall be carried out in the Republic of Lithuania for the purpose of observation of public health and factors affecting it, also for the purpose of registration of the effects and collection of information thereon.
3. State public health monitoring shall be organised or carried out in the manner prescribed by law by the institutions of state administration or executive institutions of local authorities, also by individual institutions and enterprises.
4. Public health expert examination shall be carried out in the Republic of Lithuania in order to evaluate and substantiate public health monitoring data and the management decisions.
5. Enterprises and institutions which engage in economic-commercial activities posing a threat or detrimental to public health must organise, at their own expense, in the manner prescribed by legal acts the monitoring and expert examination of public health. The lists of such enterprises and institutions shall be approved by the Ministry of Health Care.
6. The procedure of monitoring and expert examination of public health shall be regulated by laws and other legal acts.
Article 37. Control of Public Health
1. The procedure of public health control shall be laid down by laws and other legal acts. The implementation of public health control shall be co-ordinated by the Ministry of Health Care.
2. Public health control shall be:
1) state public health control;
2) municipal public health control.
3. There shall be the following types of state public health control:
1) state alcohol control;
2) state tobacco control;
3) state control of narcotic, psychothropic substances and their precursors (hereinafter - drugs);
4) state control of safety at work (to the extent it is connected with the control of compliance with the labour hygiene regulations);
5) state veterinary control (to the extent it is connected with epidemiological control of communicable diseases common to humans and animals):
6) state environmental control (to the extent it is connected with the prevention and limitation of environmental pollution detrimental to health);
7) state control of radiation safety;
8) state control of safety of food products and other products;
9) state hygiene control.
4. Municipal public health control shall embrace the control of compliance with the requirements of sanitation and hygiene regulations approved by the municipal councils.
Part III
STATE MANAGEMENT OF HEALTH ACTIVITIES
Chapter I
PECULIARITIES OF FINANCING AND ECONOMIC
REGULATION OF HEALTH ACTIVITIES
Article 38. Sources of Financing of Health Care Delivered by the NHSL
Executive Bodies
1. The sources of financing of health care delivered and services provided by the NHSL executive bodies shall be:
1) state or municipal budget fund resources;
2) compulsory health insurance fund budget resources;
3) resources of funds of insurance against accidents at work and occupational diseases;
4) voluntary health insurance fund resources;
5) resources of health funds regulated by this Law;
6) charges for paid services;
7) interest paid on the funds of individual or public health care institutions deposited with banks.
2. The procedure for financing the NHSL executive bodies with the compulsory health insurance fund budget resources shall be established by the Law on Health Insurance.
Article 39. Base Amount of Financing of the Activities of the National Health
System of Lithuania
Each year the base amount of financing of the activities of the National Health System of Lithuania, including the resources of state and municipal budgets and the compulsory health insurance fund budget resource, must account for at least 5% of the GDP value.
Article 40. State Health Fund
1. The State Health Fund shall be formed for the purpose of accumulating resources for the financing of compulsory state health programmes and for the support of programmes of public organisations aimed at health strengthening. The Ministry of Health Care shall form the State Health Fund, approve its estimate, dispose of the Fund and use its resources in the established manner. The regulations of the Fund shall be approved by the Government.
2. The sources of the State Health Fund finances shall be:
1) allocations from the State budget prescribed by the Seimas (including a part of the excise duty on alcohol and tobacco products and a part of economic sanctions for violations of legal acts regulating health activities) intended for state health programmes;
2) at least 0.7% of budget resources of the compulsory health insurance fund;
3) voluntary contributions of natural and legal persons;
4) interest paid on the resources of the Fund deposited with banks;
5) other lawfully acquired resources.
Article 41. Municipal Health Funds
1. Model regulations of the municipal health fund shall be approved by the Seimas. Municipal health funds shall be formed for the purpose accumulation of resources for the support of municipal public health programmes. The municipal health fund shall be formed by the municipal council which shall also approve its regulations in accordance with the Model Municipal Health Funds Regulations.
2. The sources of municipal health fund resources shall be:
1) the prescribed part of municipal budget allocations;
2) at least 0.3% of the compulsory health insurance fund budget, taking into account the number of residents;
3) voluntary contributions of natural and legal persons;
4) interest paid on the fund’s resources deposited with banks;
5) deductions in the amount of at least 20% from the municipal nature protection fund resources;
6) other legally acquired resources.
Article 42. Health Funds of Enterprises, Institutions, Organisations, Religious
Communities and Societies, other Legal and Natural Persons
1. Enterprises, institutions, except for the institutions maintained from the State budget, organisations, religious communities and societies, other legal and natural persons shall have the right to form health funds (hereinafter - health funds of enterprises) the resources whereof shall be used for supporting municipal health programmes, financing health protection or health strengthening programme of the enterprise, institution, or organisation, insuring the enterprise’s employees by voluntary health insurance, performing the enterprise, institution or organisation employees’ labour hygiene assessment and morbidity investigation works. The formation of the health fund and the procedure of use of the fund resources shall be established in model regulations, which shall be approved by the institution approved by the state. The fund’s estimate of expenditure shall be approved by its founder (founders).
2. The resources of health funds of enterprises shall consist of:
1) the part of the enterprise’s, institution’s profit (income) transferred to the health fund of the enterprise or institution;
2) voluntary contributions of natural and legal persons;
3) interest, paid on fund resources deposited with banks;
4) other legally acquired resources.
Article 43. Economic Measures of State Regulation of Health Relations
Health relations shall be regulated by applying economic measures regulated by laws and other legal acts, i.e.:
1) taxes;
2) compulsory health insurance resources;
3) voluntary health insurance resources;
4) resources of insurance against accidents at work and occupational diseases;
5) other types of insurance contributions;
6) state budget targeted grants;
7) soft credits;
8) pricing policy;
9) licenses;
10) economic sanctions for the violation of laws and other legal acts on health activities;
11) other economic measures.
Article 44. Priorities of Issuing State Budget Targeted Grants for the Support
of Health Activities
1. The priorities for issuing State budget targeted grants for the support of health activities shall be:
1) ensuring the process of integration into the European Union;
2) elimination of consequences detrimental to the health of the population, brought about by public health emergencies (epidemics, natural disasters, ecological disasters);
3) other priorities approved by the Government or the institution authorised by it.
2. The specific objects and measures of health activities supported by grants shall be identified by the Government on the proposal of the Ministry of Health Care.
Article 45. Investments into Health Activities and the Promotion thereof
1. Allocation and use of funds for expanding the range of health care services, acquiring and introducing new health care technologies, implementing state and municipal health programmes, improving the accessibility and adequacy of health care, developing health information systems shall be considered as investment into health activities.
2. The procedure for providing economic incentives to investment into health activities shall be established by laws and other legal acts.
Article 46. Planning of Health Activities
1. By the advice of the Government, the Seimas shall approve the Health Programme of Lithuania, which shall specify the objectives of health activities, health level indicators sought by the state as well as health activities strategies for the achievement thereof.
2. In order to perform the tasks established in the Health Programme of Lithuania, the Government, ministries, other Government institutions, county governors, municipalities shall organise the drawing up and implementation of state, county (regional) and municipal health programmes and planning documents prescribed by law or shall provide for measures for the performance of said tasks in other economic and social development programmes.
3. The procedure for drawing up, financing, implementing and exercising control over health programmes shall be established by the Ministry of Health Care.
Chapter II
HEALTH CARE GUARANTEED BY THE STATE (FREE HEALTH CARE),
HEALTH CARE SUPPORTED BY MUNICIPALITIES AND THE PROCEDURE
OF HEALTH CARE PROVISION
Article 47. Health Care Guaranteed by the State (Free Health Care)
1. Services of health care guaranteed by the state (free health care) shall be financed from the compulsory health insurance fund, state or municipal budgets, state or municipal health funds.
2. Attributed to health care guaranteed by the state (free health care) shall be:
1) basic medical aid;
2) individual health care of servicemen of the Republic of Lithuania;
3) individual health care of police and other internal affairs officers, additionally supported through the programmes;
4) individual health care of persons arrested by the police, persons kept in places of pre-trial detention, convicted persons and refugees and illegal migrants;
5) individual health care of persons specified in the Law on Health Insurance, who have been insured by compulsory health insurance;
6) provision of persons ill with diseases the list whereof is approved by the Ministry of Health Care with prostheses of limbs, joints and other organs;
7) individual health care provided to persons who are ill with tuberculosis, sexually transmitted diseases, AIDS, communicable, endocrinous, mental, oncologic diseases, alcohol dependence syndrome, drug addiction, toxic substance addiction and other diseases entered on the list compiled by the Ministry of Health Care as well as to pregnant women;
8) compensation to the persons covered by health insurance of the cost of medicines entered on the list compiled by the Ministry of Health Care and of medical aid appliances charges for which are subject to compensation from the compulsory health insurance budget;
9) public health care according to the nomenclature of the required public health care measures and services;
10) blood donorship.
3. The scope of health care guaranteed by the state shall be provided for upon assessing the demographic, health, and environmental quality indicators and their development trends.
Article 48. Health Care Supported by Municipalities
Municipalities shall support health care of the population of their respective territories by providing additional financing from the municipal budgets. Attributed to the health care supported by municipalities shall be:
1) basic medical aid of the primary health care organisation level;
2) health care of pregnant women;
3) individual health care of the unemployed, of the disabled family members;
4) health care of children under the age of 16 years;
5) health care of persons whose income is less than the amount of the state-supported income;
6) health care of orphaned persons under the age of 18 years;
7) health care of persons with Group I disability;
8) provision with dental prosthesis of persons belonging to the established categories;
9) other health care services supported by the municipality, the list and provision procedure whereof shall be established by municipal councils.
Article 49. Procedure for Providing Individual Health Care Services
Guaranteed by the State (Free) in the NHSL Institutions
1. Citizens of the Republic of Lithuania, foreign nationals and stateless persons, permanently residing in the Republic of Lithuania (hereinafter - permanent residents) shall have the right to individual health care guaranteed by the state (free). Basic medical aid shall be provided to permanent residents in the NHSL institutions free of charge irrespective of whether or not they are insured by compulsory health insurance, also regardless of the number of the patient’s visits to the institution within the calendar year and his place of residence. Foreign nationals, stateless persons not attributed to permanent residents shall be provided basic medical aid by the NHSL institutions in accordance with the procedure established by the Ministry of Health Care of the Republic of Lithuania, unless international agreements of the Republic of Lithuania provide otherwise.
2. Main conditions of provision of state-guaranteed (free) individual health care services in the NHSL institutions shall be as follows:
1) the patient’s application for the provision of free services to the physicians of primary health care, the list of whose specialities shall be drawn up by the Ministry of Health Care;
2) the patient’s application to the secondary or tertiary health care institutions for the provision of free services. In such case the patient must present the referral of the physicians specified in subparagraph 1.
3. The patient shall have the right to choose the NHSL primary health care institution and the physician according to the procedure prescribed by the Ministry of Health Care and Compulsory Health Insurance Council, also the secondary and tertiary health care institution and the physician in accordance with the conditions prescribed by this Article in order to be provided free individual health care services.
4. Conditions set forth in paragraph 2 hereof shall not be applicable to patients who apply to the NHSL institutions for the provision of basic medical aid.
5. In NHSL institutions state-guaranteed (free) individual health care shall be provided free of charge and the patient may not be charged additionally for free health care services. If patients entitled to free individual health care services choose more expensive services, materials, or forms of treatment on their own initiative, they shall have to pay, in the manner prescribed by the Ministry of Health Care, the difference between the actual prices of said services, materials and forms of treatment and the basic prices of free services, materials and forms of treatment. If patients entitled to free individual health care services choose additional services or forms of treatment on their own initiative, they shall pay the price of said services or forms of treatment.
6. NHSL institutions must provide information to the population on the types of free individual health care services, the scope of their provision and their prices.
Chapter III
OTHER PECULIARITIES OF STATE MANAGEMENT
OF HEALTH ACTIVITIES
Article 50. Professional Duties, Rights and Responsibility of Health Care and
Pharmaceutical Specialists
1. The main professional duties of health care and pharmaceutical specialists, their rights, restrictions of their practice shall be established by the laws on the Medical Practice of Physicians, on the Pharmaceutical Activities, on the Prevention and Control of Human Communicable Diseases, on the Compensation of the Rights and Damages to the Health of Patients, other laws and legal acts.
2. Health care and pharmaceutics specialists may practice, only upon being issued a license, exclusively in the speciality they have been trained in and in the cases specified by law. The Register of Health Care and Pharmaceutics Specialities shall be set up for the registration of specialities, the keeper whereof shall be the Ministry of Health Care.
3. Health care institution specialists employed in state or municipal health care institutions shall have the right to engage in private practice only outside the premises of the institutions.
Article 51. Professional Advancement of Health Care and Pharmaceutical
Specialists and its Funding
1. Professional advancement of health care and pharmaceutical specialists shall be the concern of health care and pharmaceutical activities institutions, enterprises, their founders as well as professional organisations of health care and pharmaceutical activities specialists. The contractors of the training and professional advancement of specialists shall be the Ministry of Health Care and the Ministry of Education and Science.
2. Health care and pharmaceutical specialists’ qualifications improvement procedure shall be established by the Ministry of Health Care upon co-ordination with professional health care and pharmaceutical activities specialists.
3. The costs of qualifications improvement and requalification of state and municipal health care institution specialists shall be covered with the state or municipal budget funds according to the procedure and conditions laid down by the Ministry of Health Care, unless other laws prescribe other sources for defraying the costs.
4. The costs of qualifications improvement and requalification and professional advancement of specialists of other health care and pharmaceutical institutions shall be defrayed by the institutions and enterprises or covered by the specialists themselves.
Article 52. Restrictions on the Accessibility of Information Related to Individual
Health
1. Accessibility of information related to individual health shall be restricted with a view to ensuring the inviolability of privacy and the person’s health secret.
2. It shall be prohibited to announce in the media information concerning the individual’s health without the person’s written consent. The protection of computerised information concerning individual’s health must guarantee its confidentiality.
3. Individual or public health care specialists shall be prohibited, except in cases provided by law, from violating the confidentiality of the person’s private life or information concerning individual health which constitutes the person’s health secret and which has come to their knowledge in the performance of their professional duties.
4. The criteria of the individual’s health secret shall be specified by the Ministry of Health Care.
Article 53. Medical and Public Health Care Audit
1. The management of every individual or public health care institution, facility having the right to perform individual or public health care must organise the local audit of med …
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