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Health systems in transition
Portugal
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5.3 Primary/ambulatory care
A mix of public and private health service providers deliver Portuguese primary
care. These include primary care units integrated in the NHS, the private sector
(both profit and non-profit) and groups of professionals in private offices.
The primary care network ensures, simultaneously, health promotion and
disease prevention, including the management of health problems, through
a person-centred approach oriented towards the individual, the family and
the community.
The number of publicly funded primary care centres and health posts
continued to grow throughout the 1980s and mid-1990s, showing a slight
decrease since then with a total of 387 primary care centres in 2012, covering
the whole country. However, the number of primary care facilities, including
all health posts that are part of PHCUs and FHUs, reached 1772 in 2015,
including Madeira and the Azores (see section 4.1.2). In October 2016, there
were 459 active FHUs in Portugal (SNS, 2016).
The facilities provided by each primary care centre vary widely in structure
and layout: some were purpose-built to a reasonable size, with a rational
distribution of space, and discrete areas for different purposes; some, mainly
in large cities, were incorporated into the residential buildings and are poorly
designed and not patient-friendly; and some, mainly in rural areas, were
established in old hospitals. Relatively few outpatient contacts were made in
Portugal in 2012 (4.1 per capita) compared with other European countries, being
much lower than the EU average (6.9) (WHO Regional Office for Europe, 2016).
This is consistent with the disproportionately and, arguably, inefficiently high
use of hospital care, in particular for emergency services.
Primary care in the public sector is mostly delivered through publicly funded
and managed groups (ACES). Each ACES has organizational (but not financial)
independence, and is composed of several units, which are integrated in at least
one primary care centre (see section 2.3). In practice, the ACES coordinate
primary care provision but do not have financial autonomy, which belongs to
the corresponding RHA.
The ACES mission is to guarantee the primary care provision to the
population of a given geographic area. To do so, the ACES develop prevention,
diagnosis and disease treatment through planning and provision of care to the
individuals, family and community, as well as specific activities to address
situations of greater risk or health vulnerability. The ACES also provide