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Health systems in transition
Portugal
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mechanisms to connect the population with the long-term care network. There is
a legal maximum of 74 ACES across the continental territory. The geographical
area under the jurisdiction of ACES is set by the Decree-Law No. 28/2008,
of 22 February 2008, corresponding either to NUTS III (Nomenclature of
Territorial Units for Statistics), a municipality or set of municipalities (e.g. Lisbon
has three ACES, each one covering around 250 000 people; a similar size of
population may be covered by an ACES for the area of eight municipalities),
taking into account the available resources and several sociodemographic
conditions, including:
•
the number of residents in the area, which should be between 50 000 and
200 000 inhabitants;
•
the organization of the population in the area;
•
the age structure of the population;
•
the population’s access to the hospital in the referral network (hospitals in
which patients receive care, considering their residence area).
In Lisbon and Oporto, ACES are defined at a parish level (within
municipalities) given the large population living in those cities. The aim is that
ACES have a balanced composition in terms of population, ageing structure
and location towards the referral hospital. This means that the rule for their
composition is not strict and can change over time. For example, ACES located
in the city of Lisbon were recently rearranged in terms of the parishes included
in their respective areas.
The Ministry of Health allocates funds to the RHA, which in turn negotiates
contracts (
contrato-programa
) with each ACES (see section 3.3.3).
Most primary care is delivered in the NHS by GPs as well as nurses in
the primary health settings, together with local units and long-term care units,
among others. The rest of primary care is delivered by private providers. Some
primary care centres also provide a limited range of specialized care.
The health centre, which was created in 1971, is the result of the integration
of social welfare medical services into the NHS started at the beginning of
the 1980s. Specialists who had worked for the Department of Social Welfare
were transferred and given contracts in the newly established NHS primary
care centres.
The specialists who work in primary care centres belong to the so-called
ambulatory specialties, such as mental health, psychiatry, dermatology,
paediatrics, gynaecology and obstetrics, and surgery. The current trend to