OECD Reviews of Health Systems: Lithuania 2018

24 Pages·2018·3.033 MB·English

by  OECD

State of Health in the EU
Lithuania LT
Country Health Profile 2019
The Country Health Profile series Contents
The State of Health in the EU’s Country Health Profiles 1. HIGHLIGHTS 3
provide a concise and policy-relevant overview of 2. HEALTH IN LITHUANIA 4
health and health systems in the EU/European Economic
3. RISK FACTORS 7
Area. They emphasise the particular characteristics and
4. THE HEALTH SYSTEM 9
challenges in each country against a backdrop of cross-
country comparisons. The aim is to support policymakers 5. PERFORMANCE OF THE HEALTH SYSTEM 12
and influencers with a means for mutual learning and 5.1. Effectiveness 12
voluntary exchange.
5.2. Accessibility 16
The profiles are the joint work of the OECD and the 5.3. Resilience 19
European Observatory on Health Systems and Policies, 6. KEY FINDINGS 22
in cooperation with the European Commission. The team
is grateful for the valuable comments and suggestions
provided by the Health Systems and Policy Monitor
network, the OECD Health Committee and the EU Expert
Group on Health Information.
Data and information sources The calculated EU averages are weighted averages of
the 28 Member States unless otherwise noted. These EU
The data and information in the Country Health Profiles averages do not include Iceland and Norway.
are based mainly on national official statistics provided
to Eurostat and the OECD, which were validated to This profile was completed in August 2019, based on
ensure the highest standards of data comparability. data available in July 2019.
The sources and methods underlying these data are
To download the Excel spreadsheet matching all the
available in the Eurostat Database and the OECD health
tables and graphs in this profile, just type the following
database. Some additional data also come from the
URL into your Internet browser: http://www.oecd.org/
Institute for Health Metrics and Evaluation (IHME), the
health/Country-Health-Profiles-2019-Lithuania.xls
European Centre for Disease Prevention and Control
(ECDC), the Health Behaviour in School-Aged Children
(HBSC) surveys and the World Health Organization
(WHO), as well as other national sources.
Demographic and socioeconomic context in Lithuania, 2017
Demographic factors Lithuania EU
Population size (mid-year estimates) 2 828 000 511 876 000
Share of population over age 65 (%) 19.3 19.4
Fertility rate¹ 1.6 1.6
Socioeconomic factors
GDP per capita (EUR PPP²) 23 500 30 000
Relative poverty rate³ (%) 22.9 16.9
Unemployment rate (%) 7.1 7.6
1. Number of children born per woman aged 15-49. 2. Purchasing power parity (PPP) is defined as the rate of currency conversion that equalises the
purchasing power of different currencies by eliminating the differences in price levels between countries. 3. Percentage of persons living with less than 60 %
of median equivalised disposable income.
Source: Eurostat Database.
Disclaimer: The opinions expressed and arguments employed herein are solely those of the authors and do not necessarily reflect the official views of
the OECD or of its member countries, or of the European Observatory on Health Systems and Policies or any of its Partners. The views expressed herein
can in no way be taken to reflect the official opinion of the European Union.
This document, as well as any data and map included herein, are without prejudice to the status of or sovereignty over any territory, to the delimitation
of international frontiers and boundaries and to the name of any territory, city or area.
Additional disclaimers for WHO are visible at http://www.who.int/bulletin/disclaimer/en/
© OECD and World Health Organization (acting as the host organisation for, and secretariat of, the European Observatory on Health Systems and
Policies) 2019
2 State of Health in the EU · Lithuania · Country Health Profile 2019
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1 Highlights A
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Life expectancy has increased in recent years in Lithuania but remains among the lowest in the EU. Mortality
rates from both preventable and treatable causes are well above the EU averages. The country also faces
challenges with mental health and the control of tuberculosis. Although some progress has been made in
recent years, alcohol consumption remains a major public health concern. Reducing out-of-pocket payments,
overhauling the hospital sector, further strengthening primary care and scaling up prevention measures would
contribute to improving the health of the population, but the current level of spending in health care remains too
low to address all the ongoing challenges effectively.
LT EU Health status
Years
85 Health outcomes in Lithuania remain among the worst in the EU. Life
85
80 expectancy at birth was 75.8 years in 2017, more than five years below the
80
75 EU average (80.9 years), while the gender gap in life expectancy is almost
75
70 double the EU average. Following a reduction in life expectancy between
70
65 2000 and 2007, there have been steady improvements, thanks to a reduction
65 2000 2003 2006 2009 2012 2015
in deaths from cardiovascular diseases and other major causes of death.
Life expectancy at birth
EU
LT EU Risk facLtTors
% of adults Lifestyle-related risk factors account for more than half of all deaths
in Lithuania. Alcohol consumption is higher than in any other EU
Smoking 20 %
country, although it has started to decline in recent years following the
Obesity 17 % introEdUuction of stricter alcohol control measures. In 2014, one in five
Country
adults reported smoking on a daily basis, with a rate of over one in three
Alcohol 12.3 litres among men. In 2017, 17 % of adults were obese, a proportion also higher
than the EU average of 15 %.
LT EU Health system
EUR 3 000 A single health insurance fund provides care to nearly the entire
population, but underfunding of the health system undermines
EUR 1 500
accessibility and equity. Lithuania spends much less on health than the
Smoking 17
EU as a whole, both in absolute terms and as a share of GDP. In addition,
EUR 0
2005 2011 2017 only two-thirds of current health expenditure is publicly financed,
Binge drinking 22
compared with 79 % in the EU.
Per capita spending (EUR PPP)
Obesity 21
Effectiveness Accessibility Resilience
Lithuania has among the highest General accessibility of health Addressing
mortality rates from preventable services is good in Lithuania and the persistent
and treatable causes in the EU. The the level of unmet medical needs underfunding of
quality of outpatient and inpatient reported by the population is low. the Lithuanian health system is a
care is well below EU averages, While hospital and outpatient precondition for the attainment
although some initiatives to services are widely accessible, of significantly better health
support improvements in quality coverage of pharmaceuticals and outcomes. At the same time,
of care have been undertaken in dental care is more limited, which substantial efficiency gains
Country
recent years. hamEpUers accessibility. could be reaped through a
reorganisation and downsizing of
93%
Preventable 336 93 75% LT EU the hCEoUosupnittrayl sector, while making
mortality 77 the necessary investments to
64
33%
Treatable 206 18% strengthen primary care and scale
30
mortality LT EU up prevention measures.
Hospital Outpatient Pharma- Dental
Age-standardised mortality rate care medical ceuticals care
care
per 100 000 population, 2016
Coverage for selected goods and services, 2016
State of Health in the EU · Lithuania · Country Health Profile 2019 3
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A 2 Health in Lithuania
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Lithuanians have one of the lowest lowest levels of life expectancy at birth in the EU
life expectancies at birth in the EU (Figure 1).
Life expectancy at birth in Lithuania increased by On average, Lithuanian women live almost ten years
nearly four years between 2000 and 2017, from longer than men: 70.7 years compared to 80.5 years.
72.1 years to 75.8 years. However, progress has been This gender gap is the second highest in the EU, after
slower1 than in other Baltic states (4.7 years in Latvia Latvia, and is largely due to greater exposure to risk
and 7.3 years in Estonia). In 2017, Lithuania (together factors among men, including tobacco smoking and
with Romania, Latvia and Bulgaria) had one of the excessive alcohol consumption (see Section 3).
Figure 1. Life expectancy at birth is more than five years below the EU average
Years 2017 2000
90 –
Gender gap:
4 Lithuania: 9.8 years
85 – 83. 83.1 82.7 82.7 82.6 82.5 82.4 82.2 82.2 82.1 81.8 81.7 81.7 81.6 81.6 81.4 81.3 81.2 81.1 81.1 80.9 EU: 5.2 years
9.1 4
80 – 7 78. 78 77.8 7.3
7 8
76 75. 75.3 74.9 74.8
75 –
70 –
65 –
Spain ItalyFranceNorwaIycelanSdweden MaltaCyprusIrLeluaxnedmbNoeturhgerlandsAustriaFinlanBdelgiuPmortuganlitGreed ecKiengdoSlmoveniGaermanDyenmark EUCzechiaEstoniaCroatiaPolanSldovakiHaungaLrityhuaniRaomaniaLatviBaulgaria
U
Source: Eurostat Database.
Cardiovascular diseases are the leading five deaths (15 000 deaths). The mortality rate from
cause of death in Lithuania this condition has decreased slightly since 2000, but
at a much slower rate than in other Baltic countries,
In 2016 ischaemic heart disease was the leading cause and it is now by far the highest among EU countries
of death in Lithuania, accounting for nearly two in (Figure 2).
Figure 2. Lithuania has the highest mortality rate from ischaemic heart disease in the EU
Age-standardised mortality rate per 100 000 population Lithuania Latvia Estonia EU
700
600
500
400
300
200
100
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Note: OECD estimates of EU average for 2000 and 2001.
Source: Eurostat Database.
1: Between 2000 and 2007, the country even witnessed a reduction in life expectancy.
4 State of Health in the EU · Lithuania · Country Health Profile 2019
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Figure 3. Cardiovascular diseases account for the majority of deaths in Lithuania
A
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% change 2000-16 (or nearest year) H
100 T
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Liver disease
50
Pneumonia
Prostate cancer
Colorectal cancer
0
100 200 300 400 500 600
Lung cancer Stroke
Stomach cancer Ischaemic heart disease
-50
Suicide
Chronic obstructive pulmonary disease

-100

Age-standardised mortality rate per 100 000 population, 2016
Note: The size of the bubbles is proportional to the mortality rates in 2016.
Source: Eurostat Database.
Mortality from stroke decreased slightly more over Although the authorities have achieved some progress
the same period, but still accounted for 14 % of all in reducing historically high mortality rates from
deaths in 2016 (Figure 3). Cancer is the second major suicide, it nevertheless remains an important cause of
cause of death in the country, with lung, colorectal, death, particularly among men, as Lithuania recorded
stomach and prostate cancer the most frequent the highest rate of mortality from this cause in the EU
causes of death by cancer. Mortality rates from cancer in 2016 (Figure 4). In recent years, the authorities have
decreased overall between 2000 and 2016. launched a number of suicide prevention campaigns
that led to a 45 % decrease in the number of deaths
between 2000 and 2016 (see Section 5.1).
Figure 4. Suicide is a serious public health concern in Lithuania, particularly for men
Age-standardised mortality rate per 100 000 population, 2016 Total Men Women
60
50
40
30
20
10
0
LithuaniaLatviSlaoveniHaungarByelgiumCroatiaEstoniaFinlandAustriaFranceCzechiIacelandPolandNorwaSywedeGnerNmeatnhyerlands EDUenmarRkoLmuaxneiambourgIrelanBdulgariPaortugSallovakiniateSdp aiKinngdom Italy MaltaGreeceCyprus
U

Source: Eurostat Database.
The majority of Lithuanians do not of those in the lowest quintile. This income gap in
perceive themselves to be in good health self-reported health is the second highest in the EU,
just behind Estonia, and has even increased compared
In 2017, only 44 % of the Lithuanian population to 2015 data.
reported perceiving themselves to be in good health
– the lowest rate in the EU (Figure 5). As in other
countries, people with higher incomes are more likely
to report being in good health: two-thirds of those in
the highest income quintile considered themselves
to be in good health, compared with only one-quarter
State of Health in the EU · Lithuania · Country Health Profile 2019 5
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Figure 5. The Lithuanian people report the lowest Many years of life after 65 are lived with
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U self-reported health status level in the EU some chronic diseases and disability
H
T Low income Total population High income
LI In 2017, Lithuanians aged 65 could expect to live
Ireland
an additional 17.4 years, which is 1.3 years more
Cyprus
Norway than in 2000 but still 2.5 years less than the average
Italy1
Sweden across the EU. Moreover, on average Lithuanians can
Netherlands
expect to live about two-thirds of their lives after age
Iceland
Malta 65 enduring some chronic diseases and disabilities
United Kingdom
Belgium (Figure 6). This is particularly the case among women:
Spain while the gender gap in life expectancy at age 65 is
Greece1
Denmark still five years in favour of women, there is no gender
Luxembourg
Romania1 gap in the number of healthy life years2 because
Austria Lithuanian women tend to live a greater proportion
Finland
EU of their lives after 65 with chronic diseases and
France
Slovakia disability.
Bulgaria
Germany
More than half of Lithuanians aged 65 and over report
Slovenia
Czechia having at least one chronic condition, a proportion
Croatia
Hungary lower than in the EU as a whole. These health
Poland problems in old age often result in disability. One in
Estonia
Portugal four Lithuanian people aged 65 and over report some
Latvia
Lithuania limitations in basic activities of daily living, such as
0 20 40 60 80 100 bathing, dressing or getting out of bed, which may
% of adults who report being in good health require long-term care.
Note: 1. The shares for the total population and the low-income
population are roughly the same.
Source: Eurostat Database, based on EU-SILC (data refer to 2017).
Figure 6. More than half of Lithuanians aged 65 and over have at least one chronic disease
Life expectancy at age 65
Lithuania EU
5.7
17.4 19.9
10 9.9
years years
11.7
Years without Years with
disability disability
% of people aged 65+ reporting chronic diseases1 % of people aged 65+ reporting limitations
in activities of daily living (ADL)2
Lithuania EU25 Lithuania EU25
21% 20% 25% 18%
48% 46%
31% 34% 75%
82%

No chronic One chronic At least two No limitation At least one
disease disease chronic diseases in ADL limitation in ADL
Note: 1. Chronic diseases include heart atta%ck ,o stfr opkee,o dpialebe ategs,e Pda r6k5in+so rne dpisoeratsien, Agl zdheeipmreer’ss sdiiosena ssey amndp rthoemumsa3toid arthritis or osteoarthritis. 2. Basic
activities of daily living include dressing, walking across a room, bathing or showering, eating, getting in or out of bed and using the toilet.
Source: Eurostat Database for life expectaLnitchy uaandn ihaealthy life years (data refer to 2017); SHARE survey for oEthUe1r1 indicators (data refer to 2017).
41% 29 %
2: ‘Healthy life years’ measures the number of years that people can expect to live free of disability at different ages.
6 State of Health in the EU · Lithuania · Country Health Profile 2019
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Containment of some communicable diseases has decreased over the past decade, tuberculosis
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constitutes a public health challenge remains a major public health issue in Lithuania, now U
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compounded by the rising prevalence of multidrug-
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In addition to issues linked to the growing number resistant disease forms. As reported in several other LI
of people living with chronic conditions, Lithuania EU countries, the control of measles is also an issue in
also faces important challenges with the control of Lithuania (see Section 5.1): a major measles outbreak
some infectious diseases. In 2017, the notification occurred in the first half of 2019, raising concerns
rate for all tuberculosis cases was the second highest about the immunisation coverage of children and
in the EU after Romania (Figure 7), with 1 387 cases adults in some areas of the country.
reported. Even though the number of cases notified
Figure 7. Lithuania has the second highest notification rate for tuberculosis in the EU
Notification rate for 100 000 population Lithuania Latvia Bulgaria Romania EU
150
120
90
60
30
0
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Source: ECDC Surveillance Data.
3 Risk factors
Lifestyle risk factors account for more One-third of all deaths in 2017 (13 000 deaths)
than half of all deaths in Lithuania were related to dietary risks (including low fruit
and vegetable intake, and high sugar and salt
The high mortality rates and poor health status consumption), which is nearly twice the EU
of the Lithuanian population are largely linked to average. Tobacco consumption, including direct and
behavioural risk factors. It is estimated that more second-hand smoking, is responsible for an estimated
than half of all deaths in Lithuania can be attributed 15 % (over 6 000) of all deaths. About 10 % (4 000) of
to behavioural risk factors, including dietary deaths were linked to alcohol consumption and 5 %
risks, tobacco smoking, alcohol consumption and (2 000) to low physical activity.
low physical activity (IHME, 2018; Figure 8). This
proportion is far above the 39 % EU average.
State of Health in the EU · Lithuania · Country Health Profile 2019 7
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Figure 8. The majority of deaths in Lithuania can be attributed to behavioural risk factors
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T Dietary risks Tobacco Alcohol
LI Lithuania: 32% Lithuania: 15% Lithuania: 10%
EU: 18% EU: 17% EU: 6%
Low physical activity
Lithuania: 5%
EU: 3%

Note: The overall number of deaths related to these risk factors (21 000) is lower than the sum of each one taken individually (25 000), because the same
death can be attributed to more than one risk factor. Dietary risks include 14 components such as low fruit and vegetable consumption, and high sugar-
sweetened beverages and salt consumption.
Source: IHME (2018), Global Health Data Exchange (estimates refer to 2017).
Excessive alcohol consumption on Tobacco Control in 2004 and in 2017 adopted
is still a major risk factor a complete ban on all forms of sponsorship from
the tobacco industry. Yet the estimated prevalence
Although alcohol consumption has decreased by of smoking among men calls for more gender-
about 10 % between 2010 and 2017, it remains a specific interventions targeting male smokers (see
major public health concern in Lithuania: at 12.3 Section 5.1).
litres consumed per adult in 2017, Lithuanians were
the heaviest drinkers in the EU, exceeding the EU Overweight and obesity rates among
average by 25 % (Figure 9). In 2014, one-third of men adults are slightly above the EU average
in Lithuania still reported engaging in binge drinking3
The obesity rate in Lithuania is above the EU
at least once a month over the past year, which was
average. Obesity is a known risk factor for numerous
also above the EU average (34 % compared to 28 %).
conditions including cardiovascular diseases and
Between 2016 and 2018, the government adopted
cancers. One in six adults were obese (17 %) in 2017,
a number of policies to tackle excessive alcohol
compared to one in seven (14 %) on average across
consumption. Measures included an increase in excise
the EU. This is partly the result of poor nutritional
taxes, a prohibition of alcohol sales in some places
and lifestyle habits. In 2017, nearly two-thirds of
such as petrol stations, an increase in the legal age for
Lithuanian adults (63 %) reported not eating any
purchasing and consuming alcohol to 20 years, and a
fruit on a daily basis. The frequency of vegetable
limitation of operating hours of sale (see Section 5.1).
consumption is slightly better, with 55 % of adults
Men in Lithuania smoke more than reporting that they eat at least one portion of
in most other EU countries vegetables every day.
In 2014, one in five Lithuanian adults reported While overweight and obesity rates in children are
smoking every day, which is slightly higher than lower than in most countries, this is becoming a
the EU average (20 % compared to 19 %; Figure 9). growing concern. In 2013-14, obesity rates had nearly
However, this average masks substantial gender doubled since the mid-2000s, to reach 13 % among
differences. While only 9 % of women reported 15-year-old Lithuanians.
smoking daily, more than one in three men still
Socioeconomic inequality contributes to health risks
smoked every day – the fourth highest rate in the EU.
Smoking among adolescents has declined in Lithuania
Many behavioural risk factors in Lithuania are more
over the past decade but remains relatively high:
common among people with lower education or
among 15- and 16-year-olds, 22 % of girls and 27 % of
incomes. In 2014, more than a quarter of adults (27 %)
boys reported smoking regularly in 2015.
in the lowest income quintile smoked daily, compared
to less than one in five (18 %) of those in the highest
Lithuania achieved substantial positive policy
income quintile, a gap slightly above the EU average.
developments to reduce tobacco consumption. The
government ratified WHO’s Framework Convention
3: Binge drinking is defined as consuming six or more alcoholic drinks on a single occasion for adults, and five or more alcoholic drinks for adolescents.
8 State of Health in the EU · Lithuania · Country Health Profile 2019
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In the same vein, 18 % of people without a secondary of risk factors among socially disadvantaged groups
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education were obese in 2017, compared to only 10 % contributes importantly to inequalities in health and U
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of those with higher education; this gap is much life expectancy.
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lower in the EU as a whole. This higher prevalence LI
Figure 9. Alcohol consumption in Lithuania is the highest in the EU by a wide margin
Smoking (children)
Vegetable consumption (adults) 6 Smoking (adults)
Fruit consumption (adults) Binge drinking (children)
Physical activity (adults) Alcohol consumption (adults)
Physical activity (children) Overweight and obesity (children)
Obesity (adults)
Note: The closer the dot is to the centre, the better the country performs compared to other EU countries. No country is in the white ‘target area’ as there is
room for progress in all countries in all areas.
Source: OECD calculations based on ESPAD survey 2015 and HBSC survey 2013-14 for children indicators; and EU-SILC 2017, EHIS 2014 and OECD Health
Statistics 2019 for adults indicators.
Select dots + Effect > Transform scale 130%
4 The health system
A single health insurance fund the NHIF increasingly contracts private providers for a
covers the entire population series of outpatient specialist care services.
The Lithuanian health system is organised around a Coverage through the NHIF is mandatory and, in
single insurance fund providing health coverage to theory, provides services for all residents, subject
nearly the entire population (98 % in 2018, see below). to confirmed insurance status. Uninsured people
The Ministry of Health, which governs the National remain officially entitled to free emergency care.
Health Insurance Fund (NHIF), formulates health As of December 2018, about 2 % of the population
policy and regulation and is responsible for licensing were uninsured. These may be people not in
providers and health professionals, as well as for regular employment, who failed to make statutory
approving capital investment in health care facilities. contributions, or people registered as residents but
The two main revenue sources of the NHIF consist of living abroad.
a compulsory earmarked contribution from payrolls,
In the Lithuanian system, primary care routinely
and direct transfers from the state to cover (mostly)
acts as a first contact point with the health system
economically inactive population groups, such as
for patients. It is delivered in public or private health
children, students, pensioners and unemployed
care centres, where general practitioners (GPs) often
people (OECD, 2018).
practise alongside other primary care specialists
The NHIF purchases health services through such as paediatricians, gynaecologists and mental
five regional branches. Local administrations (60 health practitioners. Primary care physicians play a
municipalities) play an important role in service gatekeeping function to more intensive levels of care;
delivery as they own a large share of primary care however, patients can reach specialists practising
centres (particularly the polyclinics) and the small- in publicly financed settings directly. Specialist
to medium-sized hospitals. They also provide some outpatient care is delivered by the outpatient
public health services. The private sector also plays departments of hospitals or polyclinics, as well as by
a role in the delivery of primary and dental care, and private providers.
State of Health in the EU · Lithuania · Country Health Profile 2019 9
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Spending on health is comparatively low Inpatient care and pharmaceuticals absorb
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H Lithuania’s spending on health care is among the
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LI lowest in the EU. In 2017, current health expenditure Spending on inpatient care was the largest cost item
accounted for 6.5 % of GDP, the fifth lowest in the in 2017, accounting for 30 % of the total health care
EU and substantially lower than EU average of 9.8 % budget. A similar share was spent on pharmaceuticals
(Figure 10). In terms of spending per person, in 2017 and medical devices (29 %). This allocation of
Lithuania spent EUR 1 605 (adjusted for differences health system resources differs substantially from
in purchasing power) – slightly more than half the EU that of most EU countries: the percentage spent
average of EUR 2 884 per person. Furthermore, only on pharmaceuticals and medical devices is much
about two-thirds (67 %) of health expenditure are higher in Lithuania (29 % vs. 18 % in the EU), while
publicly funded, a significantly lower share than the that spent on long-term care is much lower (8 % vs.
EU average (79 %). Out-of-pocket (OOP) payments4 16 %). Important variations can also be noticed when
cover the remaining third of health spending – one of comparing data from countries with similar levels
the highest shares in the EU (see Section 5.2). of health expenditure per capita: while the spending
patterns across health care functions in Lithuania
In addition, EU Structural and Investment Funds play
are very similar to those in Latvia, they differ
an important role in financing health care-related
substantially from those in Estonia, which allocates
projects in Lithuania, amounting to EUR 238 million in
relatively more resources to outpatient care and fewer
2007-13 and EUR 131 million for 2014-20 (Ministry of
to pharmaceuticals and hospital care (Figure 11).
Finance, 2019a; 2019b).
Figure 10. Lithuania spends significantly less on health care than most other EU countries
Government & compulsory insurance Voluntary schemes & household out-of-pocket payments Share of GDP
EUR PPP per capita % of GDP
5 000 12.5
4 000 10.0
3 000 7.5
2 000 5.0
1 000 2.5
0 0.0
NorwaGyermanyAustriSawNeedtehnerlanDdsenmarkFLruaxnecembourBgelgiumIrelanIdcelaUnndiFitenlda nKidngdom EU Malta ItalySpainCzechiSlaoveniPaortugalCyprusGreecSleovakLiitahuaniaEstoniaPolanHdungarByulgariaCroatiaLatviRaomania
Source: OECD Health Statistics 2019 (data refer to 2017).
4: OOP payments include direct payments, cost-sharing for services outside the benefit package and informal payments.
10 State of Health in the EU · Lithuania · Country Health Profile 2019