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Health systems in transition
Portugal
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Box 5.4
Integration of care
The fact that NHS health care units and social support units have carried out their activities without
any communication since the 1980s has led to several attempts to improve the integration of
hospital and primary care, on the one hand, and health care and social support units, on the other
hand. Several methods of integration of care can be considered.
In Portugal, horizontal integration happened with the creation of Hospital Centres that reunited,
in a single legal unit, previously autonomous hospitals. Currently, according to their geographic
influence, most hospitals in Portugal are integrated in Hospital Centres. Hospital Centres gather
hospitals that provide care within the same geographic area but were previously not linked. The
creation of Hospital Centres was the result of a political decision aimed at cost containing, without
any previous studies that supported that decision.
The creation of Local Health Units is an example of vertical integration of health care, assembling
in one unit the health care provision for a given population. The goal of Local Health Units is,
through an integrated provision and management of all services and levels of health care, to
improve interlinking between primary and hospital care provision and, eventually, other levels of
health care, namely long-term care.
A recent example of integration of care within the NHS includes the management of diabetes
patients (Dispatch No. 3052/2013, of 26 February 2013). The aim was to better integrate the
treatment of diabetes patients across all levels of health care delivery. The ACES were to provide
specialized diabetes appointments. Previously, all diabetes patients had to schedule a regular
appointment, with the corresponding increase in waiting time. At the hospitals, patients can be
treated by specialists that are more acquainted with the complexity of this condition in Integrated
Diabetes Units. The Diabetes Coordinating Units have been responsible, since 2013, for integrating
diabetes health care delivery, and connecting patients to primary and tertiary care.
Finally, one of the first effective interventions to favour integration of care between the health
and social sectors, was embodied in the creation of the National Network of Long-Term Care
(RNCCI) in 2006 as the result of intersectoral collaboration between the Ministry of Health and
the Ministry of Labour, Solidarity and Social Security. This collaboration led to the creation of
short-, medium- and long-term care aimed at patients in a situation of great dependency, but with
no need for hospitalization. The RNCCI is funded by both Ministries.