Portugal: health system review

ABSTRACT

The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policyinitiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and therole of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. The Portuguese population enjoys good health and increasing life expectancy, though at lower levels than other western European countries. All residents in Portugal have access to health care provided by the National Health Service (NHS), financed mainly through taxation. Co-payments have beenincreasing over time, and co-insurance is higher for pharmaceutical products. Approximately a quarter of the population enjoys a second (or more) layer of health insurance coverage through health subsystems and voluntary health insurance (VHI). Health care delivery is based on both public and private providers. Public provision is particularly present in primary care and hospitalcare, with a gatekeeping system in place for the former. Pharmaceutical products, diagnostic technologies and private practice by physicians constitute the bulk of private health care provision. The Portuguese health system has not undergone any major changes on the financing side since the early 1990s, despite the steady growth of public health expenditure. On the other hand, many measures have been adopted to improve the performance of the health system. Measures since 2002 have included public–private partnerships (PPPs) for new hospitals; a change in NHS hospital management rules towards a more entrepreneurial approach and a more effective purchaser–provider split; promoting generic substitution of pharmaceuticals; liberalization of prices and entry into the over-the-counter (OTC) market; administrative price reductions for pharmaceutical products; introduction of a reference pricing mechanism for pharmaceuticals facing competition from generics; regular updates of the co-payments for public health care services; reorganization of the public network of services (closure of delivery roomsin some hospitals, reshuffling of emergency departments, mergers of hospital management teams); definition of a national health plan; reform of primary care (creation of Family Health Units (USFs, Unidades de Saúde Familiar)); and creation of long-term care networks. Some of these measures have faced opposition from the (local) population, namely those related to the closure of health care facilities. There is an overall awareness, and concern, about the rise in health care expenditure in Portugal. Most of the reforms that have come into effect have done so too recently to measure any effects at the time of writing.