Abstract
<title>Abstract</title> <p>The COVID-19 pandemic placed exceptional pressure on health systems and disrupted routine healthcare delivery across Europe. In publicly financed systems, one important response was the temporary mobilisation of private healthcare providers to maintain service continuity, reduce access constraints and address capacity shortages. However, it remains unclear whether such crisis-driven public–private adjustments represented short-term adaptation or more durable changes in health system organisation. This question is particularly relevant for compulsory health insurance systems, where public financing, contractual purchasing and mixed provider participation coexist within a regulated institutional framework. This study examines how public–private healthcare dynamics evolved in Lithuania during and after the COVID-19 pandemic. A longitudinal health services case study was conducted using aggregated administrative and financial data from Lithuania covering the period 2020–2025. The analysis focused on publicly financed healthcare services purchased through the Compulsory Health Insurance Fund and Territorial Health Insurance Funds. Changes in private provider participation were examined across four dimensions: the share of public funding allocated to private providers, contractual participation in publicly financed care, service composition, and regional variation across Territorial Health Insurance Fund areas. Descriptive trend analysis and comparative regional analysis were used to assess whether pandemic-related public–private adjustments remained bounded within the existing system or indicated a more durable restructuring of publicly financed service delivery. Private healthcare providers became more visible in publicly financed service delivery during and after the pandemic, particularly in ambulatory and diagnostic services. However, the increase in private sector participation remained modest in financial scale and did not displace the public sector’s dominant role in compulsory health insurance financing. Contracting with private providers expanded under crisis conditions but stabilised in the post-pandemic period. Regional differences persisted throughout the study period, with higher private sector shares in regions where private provider capacity had already been stronger before the pandemic. The evidence does not indicate a uniform national shift towards private provision. Pandemic-related public–private adjustments in Lithuania reflected bounded health service adaptation rather than structural transformation of the compulsory health insurance system. The findings suggest that insurance-based health systems can mobilise private providers to support service continuity during crises while preserving core public financing and purchasing arrangements. The study contributes to health services research by showing how provider mix, public purchasing and regional capacity shape the limits of public–private adjustment after a major system shock.</p>