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 57% of health spending in 2015, the second lowest share in the EU after Bulgaria (Figure 12). Nearly all of the rest (42%) 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 15% These large out-of-pocket 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.