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Health systems in transition
Portugal
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covering a population between 4000 and 14 000 individuals. These teams
have functional and technical autonomy and a payment system sensitive to
performance that rewards productivity, accessibility and quality. Their main goal
is to maintain and improve the health status of people covered by them through
general health care delivery in a personalized, accessible and continued way. In
2014, the Ministry of Health created the role of the family nurse. The Ordinance
No. 281/2016, of 26 October 2016, acknowledges the need to create the specialty
of Family Nurse, to be recognized by the Portuguese Nursing Association.
Box 5.5
Assessing the strength of primary care
A recent study conducted by the OECD on the Portuguese health system shows that, overall, the
Portuguese health system is delivering high quality care at a low cost (OECD, 2015a). One of the
strengths highlighted in the OECD report is that the Portuguese primary health system is oriented
towards measuring, assuring and improving quality. For instance, unlike most OECD primary care
systems, Portugal has a large amount of available information in primary care, with a widespread
collection of a large number of indicators.
OECD also praised the recent reforms in Portugal, embodied by the creation of FHUs. This reform
aimed to improve primary care accessibility, and the efficiency, quality and continuity of care, as
well as to increase the satisfaction of professionals and citizens.
However, some challenges remain. The disparity between the performance of the old model
PHCUs and the new FHUs on key quality indicators could be a cause for concern. Also, the OECD
report highlighted three areas to which further attention could be given in the future, namely: the
use of the primary care workforce, fully exploiting available data, and making sure that primary
care contributes to the prevention and management of chronic diseases (OECD, 2015a).
In Feburary 2016, the Ministry of Health launched the “Strategic Plan for Primary Healthcare
Reform” to reprioritize the 2005 Primary Healthcare Reform and expand the number of NHS users
enrolled in a GP patient list. For this purpose, the Ministry of Health has allowed retired physicians
to return to the NHS, allowing them to accumulate their pensions with 75% of the salary they
received when they retired. Currently, there are approximately one million NHS users with no GP.
The primary care sector in Portugal is expected to play a significant and growing role in providing
health care for an ageing population characterized by a growing burden of chronic illnesses. In
the future, Portugal’s main priorities for the primary care sector ought to be, first, supporting
and expanding areas of excellence and innovation, and, second, filling in some key gaps, notably
around primary care-led prevention and co-ordination with other levels of care.
In October 2012, the Ministry of Health and medical unions signed a
new labour agreement, that was intended to lead to an important (work)
reorganization within health care facilities of the NHS, increasing access for
patients to GPs and reducing overtime pay (i.e. the money received if GPs work
more hours than those established). Overtime pay had not been in the agenda
until the introduction of the MoU. The new agreement increased the number