What Can Other Countries Learn From Lithuania’s Health and Social Care Reforms?

Lithuania is an instructive country to study precisely because its health and social-care reforms are not a finished success story. The country has substantial digital infrastructure, strong compulsory health-insurance coverage, municipalities with important social-service responsibilities and an increasingly rights-based approach to disability. At the same time, long-term care remains under reform, workforce shortages persist, access varies geographically and the historical divide between health and social services has not simply disappeared.

This combination makes Lithuania useful for international learning. The reforms explored throughout the Lithuania Ageing, Long-Term Care & Community Support Knowledge Hub show a country trying to redesign several interconnected systems while population ageing, workforce pressure and fiscal constraints continue in real time.

The transferable lessons therefore lie less in copying individual Lithuanian institutions than in examining the mechanisms of reform. Lithuania has been expanding home and community services, developing a more integrated long-term-care model, strengthening disability assessment around participation and individual needs, continuing deinstitutionalisation, investing in digital health and using European funding to build capacity. Some elements are established; others remain under implementation in 2026.

That distinction matters. International policy borrowing often focuses on the visible component of reform: a one-stop-shop, a mobile team, a digital platform or a new assessment framework. Lithuania demonstrates that these components work only when governance, funding, workforce, local implementation and evidence develop around them. The most useful international lesson is therefore not what to copy, but how to think about system change.

Lesson one: treat care reform as a system transition, not a single policy launch

One of the clearest lessons from Lithuania is that long-term-care reform cannot be reduced to passing one law or launching one new service.

Historically, responsibilities for long-term care have been divided between healthcare, social services and municipalities. Health-related long-term care is linked to the health system and compulsory health insurance, while social care operates through different legislation, municipal arrangements, state transfers and personal contributions. People may require both at the same time.

Lithuania has therefore been moving towards a more integrated model rather than simply expanding one existing programme. Technical support, national reform work and EU investment have addressed legislation, assessment, home services, integrated assistance, workforce, infrastructure and financing. By 2026 important steps have been made, but the comprehensive model remains under implementation rather than being a completed national endpoint.

This offers an important international lesson. Fragmented systems are rarely repaired by adding a coordination role on top of unchanged structures. If eligibility, funding, information and professional responsibilities remain disconnected, a care coordinator can become the person responsible for navigating fragmentation rather than removing it.

Reform therefore needs several components to move together:

• clear allocation of responsibility;
• assessment processes that recognise the whole person;
• funding arrangements that do not incentivise cost shifting;
• sufficient community and institutional capacity;
• workforce development and professional coordination; and
• information capable of following the person across services.

Not every country needs Lithuania's institutional arrangements. The transferable principle is that integration is a property of the pathway, not the title of a reform programme.

Lesson two: integration does not require every service to become one organisation

International debates about integrated care sometimes assume that organisational merger is the strongest form of integration. Lithuania's experience suggests a more practical interpretation.

The Ministry of Health, Ministry of Social Security and Labour, municipalities, health organisations and social-service providers retain distinct responsibilities. Those boundaries reflect different legislation, funding and professional functions. Reform is therefore concerned partly with making those boundaries more navigable.

Integrated assistance at home illustrates the principle. Nursing and day social care can be brought together around people with combined needs while professional functions remain distinguishable. Health and social practitioners do not become interchangeable simply because their work is coordinated.

This matters internationally because structural reorganisation can consume enormous leadership attention. Systems can redraw organisational charts while leaving referral delays, duplicated assessments and poor information exchange largely unchanged.

The more useful test is functional integration. Does the person need to tell their story repeatedly? Are changes in health visible to social support and vice versa where legitimately required? Can professionals recognise when another service should become involved? Is there a clear route when need escalates?

This connects with wider work on interoperability and system integration. Although often discussed digitally, interoperability is also organisational: different components need to work together without becoming identical.

Countries considering major structural integration can therefore learn from Lithuania's more incremental challenge. The first question should not necessarily be, “Which organisations should merge?” It should be, “Where does the person currently encounter a boundary, and what needs to change at that boundary?”

Scenario: applying the Lithuanian lesson without copying the Lithuanian structure

Consider a country where regional health organisations fund nursing while municipalities organise home support. Its government studies Lithuania and is attracted to the concept of more integrated long-term care.

Copying Lithuania literally would make little sense because the country's constitutional and funding arrangements are different. Instead, leaders map what happens to an older person who develops combined nursing and daily-living needs after hospital discharge.

They find separate assessments, different referral thresholds and no agreed process when someone's needs change. Families routinely coordinate the two systems themselves.

The reform therefore begins with the interface. A common referral route is developed for people likely to require both services. Relevant assessment information is shared lawfully, responsibilities are clarified and a review process is established for people whose needs change rapidly.

The health organisation and municipality remain separate. Funding remains different. Yet the pathway becomes more coherent.

The Lithuanian lesson has travelled, but the Lithuanian mechanism has not. That is the stronger form of international policy transfer: importing a principle after translating it through domestic institutions.

Lesson three: decentralisation needs both local flexibility and national visibility

Lithuania's 60 municipalities are central to social-service organisation. They assess needs, plan services, finance substantial provision and may deliver services directly or work with non-governmental, private and other organisations.

This creates an important advantage. Local government can respond to population composition, geography, workforce availability and existing community infrastructure.

A small rural municipality does not necessarily need the same service configuration as Vilnius or Kaunas. Travel patterns differ. Provider markets differ. The age structure may differ. Maintaining local discretion allows services to be designed around those realities.

But decentralisation creates a second requirement: the centre needs enough evidence to know when local difference becomes persistent inequality.

This is a recurring theme across Lithuania. Access to healthcare professionals and social services can vary geographically. National totals can therefore create an overly reassuring picture if local experience is not visible.

Other decentralised countries face the same challenge. National standardisation can suppress useful local innovation; unqualified local autonomy can allow inequity to become normalised.

The transferable principle is a two-level model of accountability. National government establishes rights, key standards, funding frameworks and comparable information. Local systems retain flexibility in how they respond, but significant differences in access or outcomes require explanation.

That approach makes governance and leadership a relationship between levels of the system rather than simply an organisational function.

Lesson four: community care requires infrastructure, not rhetoric

Lithuania's shift towards home and community support offers another widely relevant lesson.

Many countries now state a preference for supporting older and disabled people outside institutional settings. The principle aligns with autonomy, participation and, for many people, a clear preference to remain at home.

But “care closer to home” can become policy shorthand that conceals the resources required to make it real.

Lithuania's reforms show what community infrastructure can involve: home help, day social care, outpatient nursing, integrated assistance, personal assistance, technical aids, housing adaptation, respite, mobile teams, community rehabilitation, supported decision-making and different forms of community accommodation.

No individual component replaces the others.

An older person cannot remain safely at home because a policy prefers community care. Someone has to provide the care, the dwelling needs to be usable, family support has limits and clinical needs still require professional response.

Countries attempting to reduce institutional reliance should therefore model the capacity being transferred. If 100 institutional places are reduced, what home-service hours, workforce, respite, housing and crisis support are required instead?

The Digital Twin Scenario Modeller provides organisations with one method for exploring relationships between capacity, workforce and demand. It is not a Lithuanian or international policy model, but the underlying discipline is highly transferable: community reform should be tested against operational capacity before institutional capacity is removed.

Scenario: deinstitutionalisation succeeds on paper but not in everyday life

A government elsewhere in Europe plans to replace large disability institutions with smaller community homes. Lithuania's experience of deinstitutionalisation is studied as part of the design.

The obvious lesson would be to develop smaller accommodation. The more important lesson is different.

Policy leaders examine what happens after people move. They ask whether residents choose daily routines, participate in ordinary community life, receive support to make decisions and develop relationships beyond paid staff. They also examine whether crisis support and healthcare remain available.

The new homes are therefore judged not only through occupancy and building standards but through independence, choice and participation.

Staff roles change as well. Instead of managing a household around collective routines, workers are expected to enable different lives within the same setting. Training, supervision and staffing models are redesigned accordingly.

This does not reproduce Lithuania's disability system. It applies the deeper learning from Lithuania's continuing transition: deinstitutionalisation concerns power, choice and community membership, not simply the size or location of a building.

Lesson five: person-centred reform needs changes to assessment and resource allocation

Lithuania's 2024 disability reforms strengthened the emphasis on participation and individual assistance needs. The Agency for the Protection of the Rights of Persons with Disabilities coordinates important assessment and support functions, while the wider policy direction seeks to make assistance follow the person more effectively.

This is significant because person-centred language is relatively easy to adopt. Person-centred operating systems are harder to create.

If assessment concentrates mainly on diagnosis, impairment or service eligibility, support can still be allocated around administrative categories rather than individual goals. Lithuania's movement towards participation, individual assistance planning, personal assistance and revised community rehabilitation demonstrates a broader shift.

From 2026, community social rehabilitation for disabled people is organised with greater individual selection of service components and annual review of need rather than a fixed three-year service duration. This is a small operational detail with a larger implication: service design becomes more responsive when duration and content follow changing needs rather than an administrative cycle alone.

The international lesson is that person-centred planning and strengths-based support need practical mechanisms.

Assessment should influence what support is provided. Review should be capable of changing it. Funding needs enough flexibility to respond. The person needs genuine involvement in decisions.

Otherwise person-centred care exists primarily in policy language.

Lesson six: rights reform and service reform need to travel together

Lithuania's disability reforms and deinstitutionalisation programme also illustrate the relationship between rights and operational capacity.

International conventions can establish important expectations around autonomy, participation and community living. National legislation can strengthen those rights. Yet rights become meaningful only when people can access practical alternatives.

A right to greater choice means little if only one service exists locally. Supported decision-making requires people able to provide it. Independent living may require personal assistance, accessible housing, transport and equipment.

This is why Lithuania's combination of assessment reform, personal assistance, community services, housing adaptation and institutional transition is more informative than any single measure.

Other countries can take a similar approach without copying Lithuanian entitlements. Rights-based reform should be accompanied by a capacity assessment: what services, workforce and infrastructure would make the new right exercisable?

This also means recognising tension rather than pretending that every right can immediately be realised equally everywhere. Lithuania continues to experience geographic and workforce variation. The presence of formal support does not guarantee identical practical access.

Transparent implementation is therefore preferable to overstating success. A credible rights-based reform can acknowledge where capacity remains incomplete while maintaining a clear direction towards greater autonomy and participation.

Lesson seven: family care should be supported, not assumed

Family care has historically played a substantial role in Lithuania, particularly where formal long-term-care services have been limited. This reflects relationships, preferences and cultural expectations, but also gaps in formal support.

Lithuania's expansion of home services, integrated assistance and temporary respite demonstrates a broader policy recognition that families need support if community care is to remain sustainable.

The international lesson is particularly important because almost every care system relies on unpaid relatives to some extent.

Informal care becomes risky when public systems treat family presence as proof that formal care is unnecessary. A spouse may be willing but physically unable to provide transfers. A daughter may appear available but be reducing her employment to sustain the arrangement. Families living abroad may provide financial and emotional support but little day-to-day care.

A stronger approach distinguishes willingness, capacity and choice.

This connects with family partnership and carer support. Families should be treated as partners where the person wants them involved, not as an invisible workforce whose capacity is assumed to be unlimited.

For countries moving more care into people's homes, this becomes a system-sustainability issue. Community care that relies on escalating unpaid labour is not necessarily less resource intensive; part of its resource cost has simply been transferred to households.

Scenario: reform data improves when family labour becomes visible

A regional care system outside Lithuania reports strong progress in reducing residential admissions. Leaders initially interpret this as evidence that community reform is working.

They apply a lesson drawn from Lithuania's experience with family-heavy care arrangements and begin examining the informal support behind the numbers.

The evidence shows that some people are indeed living independently with appropriate formal support. In another group, relatives are providing more than 50 hours of unpaid assistance each week. Several carers have left employment and respite use is very low because provision is difficult to access.

The original performance indicator was correct: residential admissions had fallen. The interpretation was incomplete.

The regional authority changes its evidence framework. Carer strain, formal home-support intensity and respite access are reviewed alongside residential admissions.

Community reform is no longer judged solely by where people live. It is judged by whether the arrangement is sustainable for the person and those supporting them.

This is a powerful international lesson from Lithuania: hidden family care should be treated as part of the capacity equation rather than as an unlimited external resource.

Lesson eight: workforce reform should precede, not follow, service expansion

Lithuania's care reform is constrained by a problem familiar across Europe: the working-age population is expected to contract while demand for health and long-term care increases.

Healthcare workforce shortages are particularly important in nursing and in some geographic areas. Formal long-term-care workforce capacity has also historically been low compared with many European systems.

The government's response includes workforce training and qualification development as part of long-term-care reform. In 2026, requirements for specified professional-development programmes for nurses and nursing assistants working in long-term care were given a longer implementation period, extending relevant deadlines to 2029.

That adjustment is itself instructive. Regulation can establish an appropriate quality ambition, but implementation needs sufficient training capacity and workforce readiness.

Other countries can learn from this balance. Setting ambitious qualification requirements without examining workforce supply can unintentionally reduce service capacity. Conversely, abandoning competence requirements because recruitment is difficult risks embedding poor practice.

The stronger approach sequences reform.

Workforce planning should consider training places, supervision, pay, career progression, workload, geographic distribution, migration and retention before major service expansion occurs. New services should be modelled against the labour market rather than assuming that staff will appear once funding is allocated.

This is why workforce planning is a system-design discipline, not simply a recruitment function.

Lesson nine: investment funding should leave permanent capability behind

Lithuania has benefited substantially from European Union investment in healthcare reform, long-term care, digitalisation, community services and deinstitutionalisation.

That makes it particularly useful for countries considering major transformation funds, regardless of whether their funding comes from the EU, national government, insurance reform or another source.

Time-limited money can accelerate change. It can purchase infrastructure, establish teams, support pilots and train workers. Yet every investment creates a future operating question.

Who pays salaries when project funding ends? Who replaces equipment? What recurrent budget sustains the service? Has the project created a pathway that ordinary institutions can maintain?

The transferable lesson is to plan the exit at the beginning.

Capital approval should include recurrent operating assumptions. Pilot programmes should define the evidence required for mainstream adoption. Temporary coordination posts should have a plan for how their functions will continue if they prove necessary.

This approach changes the meaning of project success. Delivering everything promised within the grant period remains necessary, but a deeper measure is whether the permanent system becomes more capable afterwards.

Lithuania's current investment cycle therefore offers other systems an important caution: transformation funds are most powerful when they reduce future dependence on transformation funding.

Lesson ten: digital maturity is about workflow, not the number of digital systems

Lithuania's national e-health infrastructure and extensive digital public administration make digitalisation one of the country's more visible strengths.

It would be easy for another country to take the wrong lesson and conclude that the answer is simply to build a comprehensive electronic record.

The more transferable insight concerns how digital infrastructure supports operating relationships.

A digital record matters when relevant information can inform a decision. An e-prescription matters when it makes prescribing and dispensing safer or easier. A municipal digital process matters when people and professionals can actually use it.

As health and social care become more integrated, Lithuania faces the same challenge as other advanced digital systems: connecting data across institutional boundaries while maintaining legitimate privacy and purpose limitations.

The Digital Transformation Readiness Assessment can help organisations examine technology alongside strategy, interoperability, cyber resilience, workforce skills and adoption. It does not represent Lithuanian requirements, but its underlying logic reflects a key international lesson: digital capability is organisational as well as technical.

Digitalisation should therefore begin with the workflow problem. What decision is being improved? Which professional needs the information? What burden can be removed? Who may be excluded?

This also keeps digital inclusion visible. A system cannot claim better access if its most efficient route becomes inaccessible to older or disabled people who cannot use it independently.

Scenario: borrowing Lithuania's digital lesson without building Lithuania's platform

A country with fragmented regional electronic records studies Lithuania's national e-health architecture and considers developing one central system.

Before committing to structural replication, leaders analyse what they actually need to improve. Their largest immediate problem is hospital discharge: primary-care teams often receive medication and follow-up information late, while social services do not know that functional needs have changed.

Instead of beginning with a complete replacement of every digital platform, the country defines a minimum transition dataset and establishes technical standards for exchanging it between existing systems.

Staff workflows are redesigned at the same time. Information has an identified sender, recipient and purpose. Exceptions are monitored. People who cannot use digital portals retain accessible alternatives.

The architecture differs substantially from Lithuania's. The principle is similar: digital systems create value when information becomes usable across the pathway.

The country has learned from Lithuania without attempting to recreate Lithuania's technology estate.

Lesson eleven: quality reform needs to connect regulation with learning

Lithuania's social-service quality architecture involves national requirements, licensing, municipal accreditation responsibilities and provider-level assurance. The Social Services Supervisory Department has important national quality and oversight functions, while a national project running to 2029 is intended to strengthen social-service quality and expand the use of quality approaches.

This provides another international lesson: quality cannot be produced entirely through inspection.

External oversight is important because services use public resources and support people who may be vulnerable to poor care or abuse. Licensing, standards and supervision establish essential safeguards.

But sustainable quality also depends on whether organisations learn between external reviews.

Staff supervision, complaints, incidents, outcome data and feedback from people using services should change practice. A provider that waits for a regulator or municipality to identify every problem has a weak internal quality system even if it technically complies at the point of inspection.

This connects with continuous improvement. The strongest regulatory model creates minimum expectations while encouraging organisations to develop their own capacity to recognise and address variation.

Internationally, this suggests a balance. Too little external oversight can permit poor practice to remain hidden. Excessively prescriptive oversight can encourage organisations to optimise for inspection rather than outcomes.

Lithuania's continuing quality-development work is therefore useful less as a finished regulatory model than as an example of a system trying to strengthen the space between compliance and organisational learning.

Lesson twelve: measure whether reform changes people's lives

Large system reforms generate large volumes of implementation data. Lithuania's current programmes can count mobile teams, professionals trained, people receiving services, municipal expenditure, personal-assistance hours, new community settings and digital transactions.

These measures matter because public systems require evidence that promised activity occurred.

They are not the final outcome.

A long-term-care team exists so that people receive appropriate care. Personal assistance exists to enable participation and independence. Deinstitutionalisation exists to expand community living and rights. Digitalisation exists to make care safer, more connected or more accessible.

The evaluation question should therefore eventually move from “Was the reform delivered?” to “What difference did the reform make?”

Useful outcome evidence may include:

• independence and ability to remain at home where preferred;
• community participation and individual choice;
• avoidable deterioration, admission or service breakdown;
• family-carer sustainability;
• continuity and timeliness of services;
• regional differences in access; and
• the experience reported by people using support.

No single metric can capture all these dimensions. Outcomes also need interpretation: an increase in service use may indicate deteriorating population health, or it may mean previously unmet need is finally being reached.

The Quality Dashboard Builder can help organisations structure different evidence types into a more balanced picture. The specific indicators must be adapted to national institutions, but the governance principle is transferable: reform activity and human outcomes should be visible together.

Lesson thirteen: reform should expose variation instead of hiding it

Lithuania's municipal structure and geographic inequalities create a useful final lesson about transparency.

National reform can make variation more visible. As common services, assessments and data improve, policymakers can see which municipalities use services differently, where workforce is scarce and where community alternatives are less developed.

That visibility should not automatically trigger simplistic performance ranking.

A rural municipality may have legitimate higher costs because workers travel further. A city may have greater demand for specialist services because referrals are concentrated there. Higher expenditure may represent inefficiency or deliberate investment.

Variation is therefore a starting point for inquiry, not proof of failure.

The important governance question is whether persistent differences can be explained and whether the explanation is acceptable.

This approach can help other countries avoid two extremes. One is to ignore geographic variation because local systems are autonomous. The other is to impose identical service models in the name of equality.

Equity requires comparable opportunity, not necessarily identical organisation.

National systems should therefore identify material differences, investigate their causes and intervene when legitimate local variation becomes systematic disadvantage.

Governance is the common thread running through Lithuania's reforms

Across long-term care, disability, municipalities, digitalisation, quality and workforce, the same question repeatedly appears: who is responsible for ensuring that policy becomes reliable practice?

Lithuania's reforms involve ministries, municipalities, national agencies, health organisations, social-service providers and community organisations. Distributed responsibility is unavoidable in complex care systems.

Distributed responsibility should not mean ambiguous responsibility.

Every major reform needs ownership, evidence, escalation and feedback. National policymakers need to know whether implementation differs between municipalities. Municipalities need to know when provider capacity is becoming unstable. Providers need to understand who can resolve barriers outside their control.

The Governance Maturity Assessment offers organisations a way to examine these questions systematically. It is not a Lithuanian statutory framework; its international relevance lies in testing whether complex arrangements still produce clear accountability.

This is perhaps Lithuania's strongest transferable lesson. Integration, personalisation, digitalisation and community reform are often treated as separate policy ambitions. In practice they depend on the same governance capability: turning information from frontline experience into decisions about funding, workforce, service design and accountability.

What should other countries not copy?

Responsible international learning also requires clarity about what should not be transferred uncritically.

Lithuania's compulsory health-insurance system reflects its own institutional history. Its municipalities have powers and responsibilities that may sit at regional, provincial or national level elsewhere. EU funding gives Lithuania investment opportunities unavailable to countries outside the Union. Population scale also affects what can be organised nationally.

Even Lithuanian reforms recommended through international comparison were designed to be adapted to its domestic context. Earlier OECD work, for example, examined approaches used in countries including Germany, Japan, France and Denmark, but did not argue that Lithuania should simply replicate any one system.

The same discipline should apply in reverse.

Other countries should avoid copying:

• a Lithuanian institutional structure that conflicts with their constitutional arrangements;
• a funding mechanism without understanding the wider financing system around it;
• a digital model without equivalent infrastructure and public digital capability;
• community-care targets without sufficient workforce and housing capacity; or
• rights-based entitlements without resources capable of making them meaningful.

The more useful method is comparative adaptation. Identify the problem the Lithuanian reform is trying to solve, understand the mechanism being used, test whether the same mechanism fits domestic institutions and redesign it where necessary.

Lithuania also shows that reform is allowed to remain unfinished

There is a tendency in international policy writing to describe countries as models once they adopt an ambitious strategy. Lithuania is more useful when viewed without that simplification.

Its integrated long-term-care model is still being developed. Workforce pressures remain substantial. Municipal access differs. Health outcomes and socioeconomic inequalities continue to present challenges. Community alternatives are expanding but have not removed every institutional dependency.

At the same time, meaningful structural changes have occurred. Home-based and integrated services have expanded. Disability policy has moved towards participation and individual assistance. Municipal social-service expenditure has increased. Quality infrastructure is developing. Digital health is substantial. Deinstitutionalisation continues.

Both statements can be true.

This is important for countries undertaking their own reforms. System transformation rarely moves from failure to completion in one legislative cycle. Mature reform governance recognises intermediate stages, tests whether implementation is progressing and adjusts timelines or mechanisms where evidence requires it.

In 2026, for example, Lithuania extended the time available for specified long-term-care workforce qualification requirements to 2029. That is not inherently evidence of reform failure. It can be understood as an implementation adjustment intended to give providers and professionals more time to prepare.

The international lesson is to distinguish policy fidelity from implementation realism. A reform can retain its objective while changing the route or timetable used to reach it.

From policy borrowing to policy learning

The most valuable way to use Lithuania internationally is therefore not to ask which Lithuanian policies another country should copy.

A stronger set of questions is:

How has Lithuania defined the problem? Which institutional boundary is it trying to change? What workforce and funding assumptions support the reform? What has moved into everyday practice? Where does implementation remain uneven? What evidence will show whether the reform achieved its purpose?

Those questions turn comparison into learning rather than imitation.

Lithuania itself has used international evidence in this way. Its long-term-care reform development has drawn on technical support and comparison with other countries while seeking arrangements suited to Lithuanian institutions. That approach is itself worth transferring.

Countries can learn horizontally from one another while recognising that health and care systems are deeply embedded in domestic law, finance, labour markets, family expectations and political institutions.

The transferable unit is often a principle rather than a programme.

Integrated pathways may transfer. A specific ministry structure may not. Supporting family carers may transfer. A particular benefit formula may not. Measuring independence may transfer. A national assessment instrument may require complete redesign.

This more disciplined approach to international learning reduces the risk of policy tourism and increases the chance that comparison produces operationally useful change.

Conclusion

Lithuania's health and social-care reforms offer international value because they reveal the mechanics of transformation rather than a finished blueprint. The country is attempting to integrate historically divided long-term-care arrangements, strengthen community support, modernise disability policy, develop municipal capacity, use digital infrastructure more effectively and convert European investment into lasting services. Progress is substantial in some areas and incomplete in others.

The strongest lessons lie beneath the institutional detail. Integration should be judged at service boundaries rather than through organisational charts. Community care requires workforce, housing and recurrent funding. Rights become meaningful only when practical alternatives exist. Municipal flexibility works best when national systems can see persistent variation. Digitalisation should improve decisions and workflows rather than merely create more electronic records. And investment should leave permanent capability after project funding ends.

Above all, Lithuania demonstrates that reform depends on governance: someone must connect policy ambition with capacity, evidence and the lived experience of people using services.

Other countries therefore have little reason to reproduce Lithuania's system wholesale. The more useful opportunity is to examine how Lithuania is confronting problems shared across ageing societies, identify the principles that survive comparison and adapt those principles to domestic institutions. International learning becomes valuable not when systems begin to look alike, but when comparison helps each system become more coherent, sustainable and capable of supporting people to live the lives they choose.