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Health systems in transition
Portugal
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Box 5.3
A typical pathway for hip replacement in Portugal
In Portugal, someone in need of a hip replacement because of arthritis would take the
following steps:
• During a visit to the GP with whom the patient is registered, the GP refers the patient to an
orthopaedic department at an NHS hospital.
• The choice of the NHS hospital is based on the information about waiting times (available to
both GP and patient); if the patient is covered by a health subsystem or VHI, and does not want
to wait at all, private hospitals are also a choice, with variable co-payments (depending on the
health subsystem or VHI) for the patient.
• After referral, the patient may have to wait some months for the outpatient hospital appointment
with a specialist, depending on the severity of the problem.
• After the appointment, the surgery is scheduled and the patient is enrolled in the list of patients
awaiting surgery.
• If the maximum waiting time of response is achieved, the patient can be referred to either
another public hospital or a private hospital to have a timely surgery.
• Following surgery, a follow-up hospital consultation is scheduled, and the patient is also referred
to the GP, who receives a discharge summary from the hospital.
• At the primary care setting (FHU or PHCU), the patient is assessed by the GP and provision of
rehabilitation care (e.g. physiotherapy) is arranged; again, if the patient is covered by a health
subsystem or VHI, patients can choose private providers for rehabilitation.