Overall, the health system in Latvia is performing well. Despite challenging economic circumstances, in the past five years Latvia has delivered significant reforms to the hospital sector, closing a number of hospitals and 18 emergency departments in a drive to improve efficiency. Accessibility, both economic and geographical, is a major concern, with out-of-pocket payments remain high. Poor performance on some indicators of health care quality are also worrying. The chapter makes recommendations for improvement, drawing on best-practice examples from OECD countries.