Alcohol-related deaths are more than two times greater than the EU average. One-third of health spending comes from private sources - largely out-of-pocket payments. In addition, informal payments are not uncommon in Lithuania. The Lithuanian health insurance system has an effective counter-cyclical mechanism in place and was successful in protecting public spending on health at the time of the financial crises. Quality indicators provide a mixed picture, but both hospital and primary care services are improving their performance.