Question 5 of 8

Can Latvia help people live longer in good health?

About 16 min read

The short answer

Deaths can be cut a great deal, healthy years only a little. If nothing changes, a 65-year-old can expect 4.6 healthy years in 2040, fewer than today, and the queue for a doctor grows. A balanced policy cuts avoidable deaths by 15 % in 2040. It adds only 0.2 of a year of healthy life, because treatment keeps ill people alive without making them well. The policy combines excise, prevention, a larger health budget and formal long-term care.

It costs about 13 points of GDP over 2028–2045 before the EU rule responds, most of it the larger budget. Excise is the one policy that earns money. Formal long-term care is also a labour-market policy: it lets relatives who now care for family at home go to work.

Why it matters

People in Latvia live fewer healthy years after 65 than almost anywhere in the European Union. On the recorded data for 2024 a 65-year-old could expect 4.2 healthy years; in Estonia and Lithuania the figure is about twice that. The remaining years are lived with an illness that limits daily life, and those are the years that need doctors, medicines and care.

Over the next fifteen years this burden grows for two reasons. First, ageing: the large post-war generations reach the age where chronic illness is the norm. Second, longer life itself: better treatment means more people with chronic conditions live longer, which by itself raises the number of people who need care. On the base path, that is, if none of the policies on this page is introduced, healthy years after 65 fall by 0.5 of a year by 2040. The uncertainty band in the chart runs from 4.4 to 5.0 years: that is how far the path moves if the two most important assumptions about drinking and smoking are varied within their plausible range.

Why this matters beyond the health service. Every person who cannot manage without help means either state-paid care or a relative who provides it. In the model about 33 thousand people of working age are out of work in 2025 to look after a relative, and on the base path there are 39 thousand in 2040. That is a part of the workforce the page on the workforce cannot recover through migration, but this page can.

Healthy years after 65

How many more years a 65-year-old can expect to live without a limiting illness.

Healthy years after 65 3.5 4.0 4.5 5.0 5.5 6.0 2005 2010 2015 2020 2025 2030 2035 2040 years 2025 → projection Base path Healthy years after 65 3 4 5 6 2005 2015 2025 2035 2040 years 2025 → projection
  • Recorded data
  • Base path
  • Uncertainty band

The grey band shows how far the base path moves when the two most important assumptions are varied across their plausible ranges.

Show the dataDownload CSV
YearRecorded dataBase pathUncertainty band – lowUncertainty band – high
20055.25.3
20064.35.3
20074.85.3
20084.85.3
20095.25.3
20105.25.3
20114.85.2
20125.85.2
20134.15.1
20144.35.1
20154.05.1
20164.55.1
20174.25.1
20184.55.1
20194.75.1
20204.35.1
20214.75.1
20224.25.0
20234.85.0
20244.25.2
20255.15.15.1
20265.05.05.1
20275.05.05.0
20284.94.95.0
20294.94.95.0
20304.94.85.0
20314.94.85.0
20324.84.75.0
20334.84.75.0
20344.84.75.0
20354.84.65.0
20364.74.65.0
20374.74.55.0
20384.74.55.0
20394.74.55.0
20404.64.45.0

In the chart the dots are the recorded data and the line is the model's base path. Here they match less well than on other pages: the model gives 5.1 healthy years for the start of 2025, the record for 2024 was 4.2. The recorded series comes from a survey in which people rate their own limitations, and it swings up and down by half a year; the model works from the prevalence of illness and follows its average course. Both show the same downward direction, the model's level is too high, and the section "What to keep in mind" says so.

What drives it

The health system has no single loop that decides everything. It has one bottleneck, one chain and one assumption.

The bottleneck: the budget. In the model the public health budget sets how much of the treatment people need the system can deliver. Up to 2040 it is money, not the number of doctors or nurses, that binds. The need for treatment grows with ageing faster than a budget that follows the economy, so the queue lengthens and some people are not treated in time. What the health budget buys is treatable mortality: people who could be saved by timely care. That is not the same thing as healthy years.

The chain: illness, care, work. Chronic illness in old age leads to dependence on other people's help. In Latvia most of that care is provided by the family: formal care, that is, state-paid carers at home or in an institution, reaches only about a tenth of the people who need it. The rest are cared for by relatives, and some of those relatives leave work to do it. Fewer people in work means fewer contributions to pay for health and care. This chain runs one way and gets heavier every year, because the number of people who need care grows with ageing.

The assumption: drinking and smoking. Latvia is among the countries where the most pure alcohol per adult is drunk in Europe: 11.6 litres a year in 2025 in the model. Alcohol and tobacco account for a large part of avoidable deaths and for part of how many years after 65 are lived with illness. How fast consumption falls on its own, and how strongly it turns into health, are the two assumptions the uncertainty band rests on. On the base path consumption falls to 10.8 litres in 2040, and that is one reason avoidable deaths fall at all.

Over the next fifteen years ageing dominates, and no policy changes it. The budget bottleneck is what money can loosen, the chain from illness to work is what formal care can break, and the drinking assumption is what price and availability can move. The three act on different numbers, which is why no single policy ever delivers everything.

What can be done

Four policies that the government and parliament can actually introduce. For each: what it delivers in 2040 compared with the base path, what it costs the public budget, and how fast it acts. The cost to the budget is measured as the package's own effect on the budget balance, added up over 2028–2045 in points of gross domestic product (GDP, that is, everything the country produces in a year); the difference in government debt in 2040 is shown beside it, and it is smaller, because under the EU fiscal rules a package that spends is mostly paid for by cuts the rule forces elsewhere, and a package that earns lets the rule cut less.

  • Alcohol and tobacco excise

    What it is
    excise duty on alcohol and tobacco 30 % higher than planned; consumption falls, and some purchases move across the border.
    What it delivers
    alcohol consumption in 2040 4.3 % lower, avoidable deaths 1.4 % lower. Adds less than a tenth of a year of healthy life after 65.
    What it costs
    it brings the budget money, about 6.7 points of GDP over 2028–2045 (before the EU rule's response). The rule then cuts less elsewhere, so government debt in 2040 ends −0.2 points from the base path, practically unchanged. The only one of the four that earns rather than costs.
    How fast
    consumption responds at once, deaths with a lag of several years, because illness takes time to form: visible from 2033.
  • Prevention

    What it is
    prevention programmes, that is, cancer screening, vaccination, blood pressure and blood sugar checks, one and a half times as extensive as today.
    What it delivers
    avoidable deaths in 2040 6.9 % lower, healthy years after 65 0.1 of a year longer. The largest effect on deaths of the four.
    What it costs
    costs the budget about 0.7 points of GDP over 2028–2045 (before the EU rule's response); government debt in 2040 0.0 points. The price here is an assumption, not a calculation: see "What to keep in mind".
    How fast
    visible in deaths from 2029, in healthy years only from 2043.
  • A larger health budget

    What it is
    the public health budget 20 % larger than it would be if it only kept pace with ageing and prices.
    What it delivers
    the queue shrinks most: the share of people who do not get an examination because of the waiting list is 2.8 percentage points lower in 2040. Avoidable deaths 4.3 % lower. Healthy years almost unchanged.
    What it costs
    costs the budget about 14.2 points of GDP over 2028–2045 (before the EU rule's response), by far the most expensive of the four; even after the rule's cuts elsewhere, government debt in 2040 is 1.6 points higher.
    How fast
    in the queue and in deaths from 2029, that is, almost at once.
  • Formal long-term care

    What it is
    the long-term care budget doubled, twice as many care workers, a larger share of care at home rather than in institutions, and support for families who care themselves.
    What it delivers
    the number of people out of work to care for a relative is 40 % lower in 2040, about 15 thousand people. Employment 1.4 % higher. Deaths and healthy years barely change.
    What it costs
    costs the budget about 3.9 points of GDP over 2028–2045 (before the EU rule's response); government debt in 2040 practically unchanged, +0.1 points. Care costs money, but the rule covers it with cuts elsewhere, and relatives who return to work pay part of it back in taxes.
    How fast
    in care from 2029, in employment from 2033, because finding work takes time.

What the packages do

Five packages, all introduced from 2028 with a three-year phase-in. Four are one policy each at full strength; the fifth is a balanced policy: all four together, plus three smaller measures that also appear separately in the table below.

  • Excise. alcohol and tobacco excise 30 % higher.
  • Prevention. prevention programmes one and a half times as extensive.
  • Larger budget. the public health budget 20 % larger.
  • Formal care. the long-term care budget and the number of care workers doubled, more care at home.
  • Balanced policy. every policy together, including alcohol availability and tobacco control, primary care and recruiting health workers.

Deaths. Avoidable deaths are where the policies act. On the base path they fall from 480 to 470 per 100,000 residents in 2040. Prevention cuts them by 6.9 %, a larger budget by 4.3 %, excise by 1.4 %, a balanced policy by 15 %. That is hundreds of people a year who do not die early.

Avoidable deaths

Deaths that prevention or timely care could have avoided.

Avoidable deaths 300 400 500 600 700 2015 2020 2025 2030 2035 2040 per 100 000 people 2025 → projection Base path Excise Prevention Larger budget Formal care Balanced policy Avoidable deaths 300 400 500 600 700 2015 2025 2035 2040 per 100 000 people 2025 → projection
  • Recorded data
  • Base path
  • Excise
  • Prevention
  • Larger budget
  • Formal care
  • Balanced policy
Show the dataDownload CSV
YearRecorded dataBase pathExcisePreventionLarger budgetFormal careBalanced policy
2015548569
2016535553
2017525540
2018522528
2019485519
2020503510
2021644491
2022543496
2023498480
2024476
2025478478478478478478
2026479479479479479479
2027482482482482482482
2028485485485485485485
2029486486473480486467
2030487487462473487449
2031490489456468490434
2032491490457465490428
2033493490458463490424
2034490486456461487419
2035487481453459484415
2036484477450457481412
2037482475448457479410
2038479472445455476408
2039475469442454472405
2040472466439452469402

Healthy years after 65 are another story. A balanced policy adds 0.2 of a year in 2040, from 4.6 to 4.9 years, and no single policy adds more than a tenth of a year. The reason lies in the indicator itself: it counts years without an illness that limits daily life. Treatment that saves someone with a chronic illness lengthens their life but not their healthy years, and there are more such people. Only prevention and lower alcohol consumption stop illness rather than treat it, and so only they move this indicator.

Healthy years after 65

How many more years a 65-year-old can expect to live without a limiting illness.

Healthy years after 65 3.5 4.0 4.5 5.0 5.5 2015 2020 2025 2030 2035 2040 years 2025 → projection Base path Excise Prevention Larger budget Formal care Balanced policy Healthy years after 65 3 4 5 6 2015 2025 2035 2040 years 2025 → projection
  • Recorded data
  • Base path
  • Excise
  • Prevention
  • Larger budget
  • Formal care
  • Balanced policy
Show the dataDownload CSV
YearRecorded dataBase pathExcisePreventionLarger budgetFormal careBalanced policy
20154.05.1
20164.55.1
20174.25.1
20184.55.1
20194.75.1
20204.35.1
20214.75.1
20224.25.0
20234.85.0
20244.25.2
20255.15.15.15.15.15.1
20265.05.05.05.05.05.0
20275.05.05.05.05.05.0
20284.94.94.94.94.94.9
20294.94.94.94.94.94.9
20304.94.94.94.94.94.9
20314.94.94.94.94.94.9
20324.84.84.94.94.84.9
20334.84.84.84.94.85.0
20344.84.84.84.84.85.0
20354.84.84.84.84.84.9
20364.74.84.84.84.74.9
20374.74.84.84.74.74.9
20384.74.74.84.74.74.9
20394.74.74.74.74.74.9
20404.64.74.74.64.64.9

The benefit. Fewer deaths is not the only thing health money buys. The queue is what people feel first. On the base path the share of residents who do not get the examination they need because of the waiting list rises from 4.8 % in 2025 to 7.8 % in 2040, because need grows faster than the budget. A larger budget cuts it by 2.8 percentage points, which leaves the queue in 2040 about where it is today. The other policies barely change the queue.

People who cannot get care in time

Share of people who needed a medical examination and did not get it because of the queue.

People who cannot get care in time 0.0 2.5 5.0 7.5 10.0 2015 2020 2025 2030 2035 2040 % of residents 2025 → projection Base path Excise Prevention Larger budget Formal care Balanced policy People who cannot get care in time 0.0 2.5 5.0 7.5 10.0 2015 2025 2035 2040 % of residents 2025 → projection
  • Recorded data
  • Base path
  • Excise
  • Prevention
  • Larger budget
  • Formal care
  • Balanced policy

Recorded series: people reporting an unmet need for a medical examination because of waiting lists (survey).

Show the dataDownload CSV
YearRecorded dataBase pathExcisePreventionLarger budgetFormal careBalanced policy
20151.24.9
20162.54.5
20171.34.2
20181.44.1
20191.14.1
20201.74.1
20211.84.0
20222.64.2
20234.74.1
20245.14.0
20254.84.14.14.14.14.14.1
20264.34.34.34.34.34.3
20274.64.64.64.64.64.6
20285.05.05.05.05.05.0
20295.45.45.45.15.45.1
20305.75.75.74.85.74.9
20316.26.26.14.66.24.5
20326.76.76.54.46.64.3
20337.17.06.84.36.94.1
20347.37.17.04.37.04.1
20357.47.17.04.37.14.1
20367.57.27.14.47.24.1
20377.67.37.24.67.34.2
20387.67.47.34.77.44.3
20397.77.57.34.87.54.3
20407.87.67.45.07.64.4

The second benefit is in the labour market. Formal long-term care frees the relatives who provide care themselves today: in 2040 1.4 % more people are in work, about 11 thousand, and a balanced policy gives 1.6 % more. That is comparable to what opening immigration delivers on the workforce page, except that these people are already in Latvia and already speak the language. Not every freed relative returns to work: in the model most do, the rest are of pension age or stay at home.

Employment

People aged 15 to 74 in work.

Employment 700 800 900 1,000 2015 2020 2025 2030 2035 2040 thousand 2025 → projection Base path Excise Prevention Larger budget Formal care Balanced policy Employment 700 800 900 1,000 2015 2025 2035 2040 thousand 2025 → projection
  • Recorded data
  • Base path
  • Excise
  • Prevention
  • Larger budget
  • Formal care
  • Balanced policy
Show the dataDownload CSV
YearRecorded dataBase pathExcisePreventionLarger budgetFormal careBalanced policy
2015969967
2016962959
2017947946
2018942939
2019933931
2020897900
2021878876
2022872868
2023878872
2024872869
2025865862862862862862862
2026858858858858858858
2027851851851851851851
2028840840840840840840
2029829829829829829829
2030822822822822822822
2031814813814814815815
2032805805806806808809
2033798797798798802803
2034791791791792797798
2035785785785785792793
2036779779779779787788
2037772773773773781783
2038767767767767777778
2039761762762762772773
2040756756757756767768

The price. Public spending on health and long-term care rises on the base path from 5.3 % of GDP in 2025 to 5.8 % in 2040 from ageing alone. A larger budget adds another 0.8 points, formal care 0.3, a balanced policy 1.3. The recorded dots in the chart sit below the model's line because the recorded series covers health care only, without long-term care.

Public spending on health and long-term care

What the state spends on health care and care for dependent people.

Public spending on health and long-term care 3 4 5 6 7 8 2015 2020 2025 2030 2035 2040 % of GDP 2025 → projection Base path Excise Prevention Larger budget Formal care Balanced policy Public spending on health and long-term care 2 4 6 8 2015 2025 2035 2040 % of GDP 2025 → projection
  • Recorded data
  • Base path
  • Excise
  • Prevention
  • Larger budget
  • Formal care
  • Balanced policy

Recorded series covers health only.

Show the dataDownload CSV
YearRecorded dataBase pathExcisePreventionLarger budgetFormal careBalanced policy
20153.44.8
20163.54.8
20173.54.9
20183.85.0
20194.15.1
20204.85.1
20216.57.6
20225.35.3
20234.35.2
20245.3
20255.35.35.35.35.35.3
20265.45.45.45.45.45.4
20275.45.45.45.45.45.4
20285.45.45.45.45.45.4
20295.55.55.55.85.55.9
20305.65.65.66.25.76.3
20315.65.65.76.65.76.7
20325.65.65.76.65.86.8
20335.65.75.76.65.86.8
20345.65.75.76.65.96.9
20355.65.75.76.65.96.9
20365.75.85.86.66.06.9
20375.75.85.86.66.06.9
20385.85.85.86.66.17.0
20395.85.85.86.66.17.0
20405.85.85.86.66.17.1

For the budget it looks like this. Before the EU rule's response, prevention costs about 0.7 points of GDP over 2028–2045, formal care 3.9, a larger budget 14.2, a balanced policy 12.7; excise earns about 6.7 points. The balanced policy costs less than the larger budget alone because the excise covers part of it. In government debt most of this disappears. Debt was 47 % of GDP in 2025; on the base path it rises to 61 % in 2040, and why it rises is explained on the public finances page. Because the rule binds, a package that spends is mostly paid for by cuts elsewhere, and one that earns lets the rule cut less: in 2040 debt is 1.6 points higher under the larger budget, 0.6 under the balanced policy, and within a point of the base path under the other three.

Government debt

What the state owes, as a share of what the country produces in a year.

Government debt 30 40 50 60 70 2015 2020 2025 2030 2035 2040 % of GDP 2025 → projection Base path Excise Prevention Larger budget Formal care Balanced policy Government debt 20 40 60 80 2015 2025 2035 2040 % of GDP 2025 → projection
  • Recorded data
  • Base path
  • Excise
  • Prevention
  • Larger budget
  • Formal care
  • Balanced policy
Show the dataDownload CSV
YearRecorded dataBase pathExcisePreventionLarger budgetFormal careBalanced policy
201538.340.9
201641.739.9
201740.340.0
201838.338.4
201937.936.8
202044.039.2
202145.941.9
202244.443.5
202344.442.3
202446.243.5
202546.944.544.544.544.544.544.5
202645.445.445.445.445.445.4
202747.747.747.747.747.747.7
202849.849.849.849.849.849.8
202950.950.850.950.950.950.8
203052.051.652.052.352.051.9
203153.452.653.554.353.553.5
203254.153.154.255.754.454.8
203354.953.955.057.355.556.4
203455.855.156.058.557.158.0
203557.256.857.459.858.959.8
203658.758.458.861.060.361.0
203760.360.160.462.461.662.1
203861.161.061.263.062.162.5
203961.761.561.763.462.262.6
204061.261.061.262.861.361.8
All packages that were run
PackageDescriptionHealthy years after 65 2040, pointsGovernment debt 2040, points
Alcohol availability and tobacco controlFewer outlets and hours for alcohol sales and twice as strict tobacco control: measures without a price and without a cost to the budget.+0.1+0.2
Primary careA larger share for family doctors in the health budget and one and a half times more productive clinical work; no extra money.0.0+0.1
Health workersOne and a half times as many nursing students, pay 15 % higher and three times as many health workers from abroad.0.0+0.1

Assessment

Package Healthy years 2040 Avoidable deaths 2040 Queue 2040, points Employment 2040 Budget cost 2028–2045, points of GDP Government debt 2040, points Who gains, who pays Confidence
Excise +0.04 −1.4 % −0.2 0.0 % +6.7 −0.2 the budget and those who drink less gain; buyers pay, the poorest most; some purchases go across the border medium
Prevention +0.08 −6.9 % −0.4 +0.1 % −0.7 0.0 those whose illness is caught early gain; the budget pays, but the price is an assumption low
Larger budget +0.02 −4.3 % −2.8 0.0 % −14.2 +1.6 those in the queue gain; the budget pays, dear per life saved medium
Formal care 0.00 −0.6 % −0.2 +1.4 % −3.9 +0.1 dependent people, their relatives and the labour market gain; the budget pays and recovers part in taxes low
Balanced policy +0.23 −14.7 % −3.4 +1.6 % −12.7 +0.6 all of the above gain; the budget pays, the excise covers part medium

Healthy years: difference in years. Deaths and employment: difference from the base path in per cent. Queue and debt: difference in percentage points. Budget cost: the package's own effect on the budget balance before the EU rule's response, added up over 2028–2045 in points of GDP; a cost reads negative, an earning positive. Confidence: how sure the direction and size of the result are, given the assumptions it rests on.

The table says four things. First, the goal "more healthy years" is not reachable with these policies by 2040: even a balanced policy recovers only part of what the base path loses. What can be achieved is fewer early deaths and shorter queues, and that is not nothing. Second, money and prevention buy different things: the budget buys treatment and shorter queues, prevention and excise buy less illness. A system that only treats gets dearer every year. Third, excise is the only policy that brings the budget money, and it is worth introducing before the others so that it can pay for them. Fourth, formal long-term care is at the same time a labour market policy: it changes neither deaths nor healthy years, but it frees tens of thousands of people for work, and no other policy on this site does that at that price.

For a decision-maker this gives an order: first excise and prevention, which stop illness and barely burden the budget; then formal care, whose gain is in the labour market; and a larger health budget as the answer to the queues, knowing that it is the dearest route per life saved.

What to keep in mind

The model shows healthy years too high. On the record a 65-year-old in 2024 could expect 4.2 healthy years; the model gives 5.1 for 2025. The recorded series comes from a survey of self-reported limitations and swings by half a year from one year to the next; the model follows the prevalence of illness. The downward direction is the same on both sides, but the level on this page should be read as "about this much", not as a precise figure.

Why healthy years fall even as deaths fall. The indicator counts years without a limiting illness. If treatment saves more people with chronic conditions, they live longer, but with the illness, and the average number of healthy years after 65 can therefore fall. That is not a flaw in the model, it is a property of the indicator, and it is worth knowing before healthy years are made the only goal.

The price of prevention is an assumption. In the model prevention programmes have no budget line of their own; their price is assumed as a small increase in the health budget. The effect on deaths is calculated, the price is not, which is why prevention's confidence in the table is low. Read it as: this is what a prevention system that worked would be worth.

How many relatives return to work is an assumption still being tested. In the model every person out of work to care for a relative corresponds to a set share of the people who need care; in Latvia that share has not been measured. If in reality half as many relatives have left work, the labour market gain from formal care is half as large; if more, larger. The direction, and the fact that care partly pays for itself in taxes, do not change.

Excise and the border. When Latvia raises excise, some purchases move to Lithuania or Estonia: people drink almost as much but pay the tax elsewhere. The model takes this into account, so the budget gain from excise is smaller than it would be without a border, but it is still a gain. If the neighbours raise excise at the same time, Latvia's gain is larger.

Workforce and primary care show nothing to 2040, and there is a reason. The table of all packages shows that more nurses, a larger share for family doctors or more productive work change neither deaths nor the queue. In the model the constraint up to 2040 is money, not people: without a larger budget the extra staff have nothing to do. That does not mean staff shortages are not a problem; it means the model sees them only together with the budget, and after 2040 they become a constraint in the model too.

The uncertainty band covers two assumptions, not all. They are how fast alcohol consumption falls on its own, and how strongly drinking and smoking turn into illness after 65. Other assumptions, for example what the budget buys in a given year, are not in the band.

After 2040 the base path keeps falling. Healthy years after 65 are 4.4 in 2045 on the base path, and the balanced policy adds 0.3 of a year then; government debt is 0.6 points lower than on the base path by 2045, because relatives who return to work pay taxes for longer. Those years rest on more assumptions than the years before, which is why the page prints 2040.

The 2028 start is an assumption. Every package starts in 2028 and reaches full strength in 2030. A later start shifts everything to the right; the result in 2040 is then smaller, but the relations between the policies are the same.

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