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We present a general overview of the health care system as well as the pricing and reimbursement environment in Latvia. Overall, the pharmaceutical sector in Latvia, including pricing and reimbursement, is strictly regulated. The main Latvian stakeholder in the pharmaceutical sector is the Ministry of Health. The State Agency of Medicines and the National Health Service (NHS) are also important institutions for regulation of pharmaceuticals, including pricing and reimbursement. The NHS is the most important institution for regulation of reimbursement of pharmaceuticals. It is responsible for health technology assessment and also for implementing decisions regarding the reimbursement of pharmaceuticals by including medicines in the positive reimbursement lists for outpatient care and defining positive lists of medicinal products for inpatient use. The reimbursement of expenditures for medicinal products and medicinal devices for outpatient care is a main part of drug funding in Latvia. Reference pricing is in place and prices are revised 4 times a year. The positive reimbursement list for outpatient care consists of three parts: list A, list B, and list C. All the medicines in the positive list are classified into one of three reimbursement categories (100%, 75%, or 50%) depending on the illnesses for which they have been approved. Pharmaceuticals used for inpatient care are included in the cost of inpatient services and are provided free of charge to patients. Inpatient drugs are purchased by health service providers., (Copyright © 2017. Published by Elsevier Inc.)

Death certificates were reviewed for the 543 Alberta women who died during the period 1969 through 1978 and for whom the underlying cause of death was coded as uterine cancer. To evaluate the recorded cause of death Alberta Cancer Registry records, which existed for 97% of the women, were examined. Calculations from the revised information showed an increase in the mortality of cancer of the corpus uteri and a decrease in the mortality of cancer of the cervix uteri over the 10-year period, but neither was statistically significant. During the same period in Alberta the incidence of cancer of the corpus uteri increased significantly and the incidence of cancer of the cervix uteri decreased significantly.

We assessed the mortality rates by age, sex, race, blood type, primary diagnosis, treatment and transplantation history of 8432 patients in Canada for whom end-stage renal disease (ESRD) was diagnosed between 1981 and 1986. Significant differences in the probability of dying were found between those with and without diabetes mellitus, between those who had received a renal transplant and those who had not, between white and nonwhite patients and between various age groups. The mortality rates of the ESRD patients were at least three times higher than those of the general Canadian population. Primary diagnosis and treatment were significantly associated with the risk of dying among the ESRD patients. For those who had received a transplant, the length of time spent waiting for a transplant was positively associated with the risk of death from ESRD. Patients who had received peritoneal dialysis before transplantation had a higher risk of death than those who had received either hemodialysis (risk ratio 1.3) or transplantation (risk ratio 3.2) as the first treatment. No significant differences were found in the cause of death between those who had received peritoneal dialysis and those who had received hemodialysis. Almost half of the deaths among women without diabetes who had received a transplant were due to infection.

A population-based computer record linkage of infant births and deaths was conducted for 1978 and 1979 covering Canadian provinces. Birthweight was inversely related to risk of postneonatal death for all causes examined, including accidental deaths. Length of gestation was inversely associated with risk, but the strength of the relationship was much weaker than that noted for birthweight. A logistic regression model was used to assess the effects of variables, as reported on birth certificates, on postneonatal mortality. Maternal age less than 25 years, unmarried marital status and one or more previous births were all statistically significantly related to increased risk.

A population-based computer record-linkage study of infant births and deaths in 1978 and 1979 in eight Canadian provinces (Quebec and Newfoundland were excluded) was undertaken to permit analysis of perinatal mortality in relation to maternal and infant characteristics. Perinatal mortality rates were significantly higher in nonurban than in urban areas (p less than 0.05). A logistic regression model was used to assess the effects on perinatal mortality of variables reported on birth and stillbirth records. This model included length of gestation, infant's birth weight and sex, number of previous births and number of previous stillbirths as well as an interaction term for length of gestation and birth weight. For early-neonatal mortality, odds ratios over 8 were observed for birth weight less than 2500 g or gestation less than 35 weeks. About 75% of early-neonatal mortality was attributable to low birth weight or fetal immaturity. Greater emphasis should be placed on the prevention of low birth weight.