furthermore procedures that might be expected to be covered such as thoracic surgery and some neurological procedures are not included a failure to make such services systematically available limits access to good quality care public funding only accounted for of health spending in the second lowest share in the eu after bulgaria figure nearly all of the rest is paid out of pocket by patients themselves this is the third highest share in the eu after cyprus and bulgaria and nearly three times the eu average of these large outofpocket payments constitute a substantial barrier to accessing medical care for many latvians as reflected in the high levels of unmet medical and dental care needs