OECD Reviews of Health Systems: Lithuania 2018 The report analyses the performance of Lithuania’s health system which has been long characterised by its institutional stability and the steady pursuit of a policy agenda aimed at adapting it to the evolving burden of disease. Today even if total spending on health is low and out of pocket payments represent nearly a third of it the system ensures fairly equitable access to care. The main challenge to the system is that health outcomes still place Lithuania among the lowest ranked in the OECD. Efforts need to be geared more systematically towards strengthening public health and improving the quality of the services delivered at primary and hospital care levels.