Assessment of Lithuanian trauma care service using a conceptual framework for assessing the performance of health system.

BACKGROUND Injury is the number one public health problem in Lithuania in terms of disability adjusted life years lost. The trauma system plays an important role in injury statistics. The objective of this article is to describe and assess the performance of Lithuanian trauma sector. METHODS The framework for assessing the performance of health systems proposed by Murray and Frenk (2000) was employed. RESULTS The primary intention criterion--to reduce the number of trauma cases, injury related mortality and disability rates by 30% by 2010-is well defined. The Lithuanian whole-trauma sector does not substantially contribute to improving the health of the population. The legitimate expectations of the community--respect of persons in terms of dignity, autonomy, confidentiality, client orientation--do not correspond with the responsiveness of the trauma service. Financing of the trauma sector does not correspond with the magnitude of the injury problem. Lithuanian trauma service is decentralized. There is no trauma leadership in the country. There is no national policy for unintentional injury prevention and control, no specialized injury research institute, no system of trauma centres, and no Injury Surveillance System in Lithuania. There is no such specialty as Emergency Medicine as of 2009. A political and public will to reform the trauma sector is not sound. CONCLUSION The performance of the decentralized Lithuanian trauma sector does not match with the primary intention criterion and does not correspond to the needs of people. Lithuanian trauma service has to be conceptualized and changed to inclusive.