Latvia’s health system broadly delivers effective and efficient care to the population within a context of significantly fewer resources – and higher health care needs – than most OECD countries. Latvia has successfully consolidated its hospital sector and strengthened primary care. Average length of stay in hospital fell by almost 15% between 2005 and 2013, and GPs are now required to follow up on patients who called for emergency medical assistance but were not hospitalised. OECD health systems could learn much from these reforms as well as longer-standing institutions, such as Latvia’s feldshers (physician assistants). Latvia nevertheless faces important challenges to improve the performance of its health system. Up to one in five Latvians report forgoing health care because of the cost; waiting times for key diagnostic and treatment services can be long; and inclusion of key treatments in the publicly-funded benefits basket does not always reflect latest best practice. Critically, the health system lags behind many OECD countries in the extent to which data are used to systematically measure, compare and improve the performance of services, especially at more granular provider or local levels. This review aims to support Latvia in continuing reform of its health system, informed by international best practice.