Health Systems in Transition

Health systems in transition

Portugal

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emergency services. This leads to excessive demand on emergency departments

and considerable misuse of resources as expensive emergency services are often

used for relatively minor complaints.

The major problems currently faced by primary care include:

•

an inequitable distribution of health care resources (staff shortages in

remote areas), resulting in limited access to health care services for poorer

and geographically isolated people;

•

difficult access, resulting in emergency department overuse;

•

very limited public provision of services in continuing and home care,

despite recent developments (see section 5.8);

•

mixed opinions by sectors of the population about the public primary

care system;

•

scarcity of quality control programmes, despite efforts by the DGH

(e.g. launching programmes to improve quality) (see section 7.6);

•

a lack of motivation of GPs working in remote areas for fixed salaries;

•

a shortage of qualified ancillary staff in primary care centres

(see section 4.2.2).

A series of health care reforms, initiated in 1995/1996, aimed to tackle these

problems by increasing accessibility, improving continuity of care, increasing

GP motivation with a new payment system (see section 3.7.2,

Doctors

stimulating home care services (see section 5.8) and improving quality.

The NHS has restructured the primary care services (see section 6.1) and

this intervention included:

•

implementation of local health units (

Unidades Locais de Saúde

)

(since 1999);

•

development of information systems (mainly since 2007);

•

implementation of the Family Health Units (2007);

•

reconfiguration and autonomy of primary care centres, by creating

the ACES (Decree-Law No. 28/2008, of 22 February 2008);

•

restructuring of public health services (2009).

The initial phase – the one that has had most public visibility – was the

creation of FHUs, which consist of small teams of three to eight GPs, the same

number of family nurses and a variable number of administrative professionals