Key points
- Lithuania runs the Bismarck model: mandatory health insurance administered by the National Health Insurance Fund (NHIF).
- Coverage is about 99% of residents, funded by payroll contributions from the working population and government budget allocations for the non-working population.
- Care is delivered by municipal primary care centres and hospitals, with many outpatient specialist services — notably dental care — provided privately; family doctors act as gatekeepers.
- Patients need a GP referral to access publicly financed specialist and inpatient care, and households paid 31.0% of health spending out of pocket in 2023 (WHO Global Health Expenditure Database).
- Life expectancy at birth was 77.6 years in 2023, and health spending was 7.6% of GDP in 2024 (OECD Health at a Glance 2025).
Direct answer: Lithuania runs the Bismarck model: mandatory health insurance administered by the National Health Insurance Fund (NHIF). The system is financed primarily through contributions to the mandatory scheme — payroll contributions from the working population and allocations from the general government budget for the non-working population — which help to maintain population coverage at about 99% of residents. Municipalities own publicly financed primary healthcare centres and most district and nursing hospitals, while many outpatient specialist services are private. Patients need a GP referral to access publicly financed specialist outpatient and inpatient care, and households paid 31.0% of health spending out of pocket in 2023 (WHO Global Health Expenditure Database). Life expectancy at birth was 77.6 years in 2023 — and healthy life expectancy 66.1 years — and health spending was 7.6% of GDP in 2024 (OECD Health at a Glance 2025; WHO Global Health Estimates, October 2026).
At a glance
| Item | Detail |
|---|---|
| Model | Bismarck — mandatory health insurance (NHIF) |
| Who pays | Payroll contributions from the working population and government budget allocations for the non-working population, pooled in the NHIF; the Ministry of Health regulates the system and governs the NHIF |
| Who delivers | Municipal primary healthcare centres and district and nursing hospitals; the private sector is limited in inpatient care, but many outpatient specialist services are private — notably dental care; family doctors often operate privately |
| What is free at the point of use | Covered services with a GP referral; dental care is mostly paid for privately, and patients pay co-payments on medicines and some services |
| Life expectancy at birth | 77.6 years (2023, OECD Health at a Glance 2025) |
| Health spending | 7.6% of GDP (2024, OECD Health at a Glance 2025) |
| Source for the model and coverage | State of Health in the EU: Country Health Profile 2025: Lithuania (OECD and European Observatory on Health Systems and Policies) |
Figures are a snapshot checked 7 November 2026, not a live feed. No country is ranked as best.
How the system works
The health system is financed primarily through contributions to a mandatory health insurance scheme, administered by the National Health Insurance Fund (NHIF). Payroll contributions from the working population and allocations from the general government budget for the non-working population help to maintain population coverage at about 99% of residents in 2022. The Ministry of Health is responsible for regulation and policy making; it also governs the NHIF and oversees several subordinate agencies tasked with medicines control, public health functions, and the licensing of services and health professionals. In addition, the Ministry (co)owns some healthcare providers, including all tertiary hospitals.
Municipalities are responsible for certain public health functions; they also own publicly financed primary healthcare centres and most district and nursing hospitals. The private sector remains limited in inpatient care, but many outpatient specialist services are private — notably dental care. A considerable number of general practitioners (known as family doctors in Lithuania) operate privately. The NHIF routinely contracts with private providers for primary and certain specialised outpatient services. A major restructuring reform was initiated in 2023, including centralising ambulance services (completed in 2024) and ongoing efforts to establish municipal health centres, as well as creating a more integrated framework for long-term care and clustering some hospital services.
Who pays, and what people pay
Payroll contributions and the government budget pay for the system through the NHIF. Public funding accounted for 68% of health spending in 2023, and mandatory prepayment covered 67% of spending (OECD Health at a Glance 2025). What patients pay is substantial: out-of-pocket payments accounted for 31.0% of health spending in 2023, while spending on voluntary health insurance was very low, at 1.6%. Patients need a referral to access publicly financed specialist outpatient and inpatient care, but it is possible to pay directly for faster access. Outpatient care remained the largest spending category in 2023, accounting for 35% of current health expenditure, followed by inpatient care at 27% and medical goods — pharmaceuticals and medical devices — at 27%.
What is free, and what is not
Free at the point of use: covered services with a GP referral, including primary care, specialist outpatient care and inpatient care under the NHIF. What is not free is the margin: dental care is mostly provided privately and paid for directly, medicines carry co-payments, and long-term care — at 8% of health spending, against 18% across the EU — is thinly covered. The workforce is stretched unevenly: physician density was 4.6 per 1,000 population in 2023, the highest level since 2000 and above the EU average of 4.3, but there were 7.5 practising nurses per 1,000 — the lowest ratio since 2010 and below the EU average of 8.5 — with a 10-fold difference in nurse density across municipalities in 2023.
How it compares
Lithuania spends 7.6% of GDP on health — below the OECD average of 9.3% — and $4,259 per person, below the OECD average of $5,967 (USD PPP, 2024). Its life expectancy of 77.6 years is 3.5 years below the OECD average of 81.1 years (OECD Health at a Glance 2025), and the sixth-lowest among the OECD profiles in this set, after Mexico (75.5 years in 2024), Latvia (75.6), Hungary (76.7), Türkiye (77.3 years in 2022) and Colombia (77.5 years in 2024). Its distinguishing feature is the mortality behind the figures: avoidable mortality rates are almost double the EU average, driven predominantly by premature deaths from ischaemic heart disease, and Lithuania had the fourth-highest rate of avoidable mortality in the EU in 2022. Compare countries side by side in the Health System Comparison tool, or read the other profiles in the country index.
Frequently asked questions
Is Lithuanian healthcare free?
Covered services are free at the point of use once a patient has a GP referral, but dental care is mostly paid for privately and households still paid 31.0% of health spending out of pocket in 2023.
What is the NHIF?
The National Health Insurance Fund: the single fund that administers Lithuania's mandatory health insurance, pooling payroll contributions and government budget allocations and contracting with public and private providers.
What changed in the 2023 reform?
A major restructuring began in 2023 to consolidate and integrate services: ambulance services were centralised (completed in 2024), municipal health centres are being established as a new provider model, and hospital services are being clustered, with a more integrated framework for long-term care.