Since the collapse of the communism, all countries in Central and Eastern Europe adopted social health insurance (SHI), except Latvia (Rechel & McKee, 2009). Since the late 1980s, there have been several attempts to introduce SHI as a healthcare-financing model. Even Despite these attempts, healthcare in Latvia continues to be financed through general taxation. This paper focuses on the period between 2003 and 2013 when efforts to change the healthcare financing system were intensified and culminated with the legislation draft reaching Parliamentary reading.
In 2003 I. Circene became the Minister of Health for the first time. As a part of health reform, she proposed the introduction of SHI. The idea did not garner support among stakeholders and was dropped. In 2011, she was Minister for the second time and revived the same idea, even though in 2011 the establishment of a general taxation-based system was finalized (Mitenbergs et al., 2012). In 2013 the proposed law passed the first reading in the Parliament but was dropped in second. In-between time in office, she kept building coalitions with domestic and international stakeholders. Additionally, strongly seeking support from IOs to push through the proposal.
Countries are not isolated decision-making entities; very strong interdependencies with international organizations (IOs) influence national health policies (Kaasch, 2015). National and international actors unite themselves in coalitions, to dominate the policy-making (Cairney, 2015). For this reason, the Advocacy Coalition Framework (Sabatier, 2007) is applied with complimenting causal mechanisms, by addressing “how” and “why” policymaking took place (Capano & Howlett, 2019; Van der Heijden, Kuhlmann, Lindquist, & Wellstead, 2019).
The data is gathered from grey literature, document analysis and interviews. The main contribution is the knowledge of how interaction with IOs plays a role in the domestic coalition-building process, and how domestic actors are using IOs for their agenda.
