Health Systems in Transition - Portugal

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Health systems in transition Portugal 118
Recently, Ordinance No. 147/2016, of 19 May 2016, revoked the Ordinance
no. 82/2014, of 10 April 2014. According to this new Ordinance, a new hospital
classification will only be published after the approval of hospital referral
networks for all hospital specialties.
Most hospital services are provided according to the integrated model
directly run by the NHS. However, nonclinical services, such as maintenance,
security, catering, laundry and incineration have for some time been contracted
out to the private sector.
Also, diagnostic and therapeutic services in the ambulatory sector are
partially provided by the private sector through “any willing provider” contracts
(see section 5.3). A very limited number of clinical services are contracted
out, usually in specific areas where waiting list reductions are needed. The
Integrated System to Manage the List of Patients Enrolled for Surgery (Sistema
Integrado de Gestão de Inscritos para Cirurgia) is the tool that allows response
to urgent situations to be improved. For instance, when the maximum time of
response is reached, the patient can be referred to either another public hospital
or a private hospital to have timely surgery.
Decisions on the outsourcing of services are usually made at the hospital
administration level, while the decision to contract providers for specific clinical
services, usually within waiting list recovery programmes (i.e. programmes
aimed at reducing waiting lists for surgery), remain at the RHA level.
Health resources follow the distribution of the Portuguese population, which
is mainly concentrated along the coast. At present, existing hospitals in Alentejo
and Algarve offer only some medical and surgical services. In Alentejo, there
are three hospitals with less specialized services, which are local health units,
and one hospital providing medical and surgical services that are not provided
by local health units (Hospital of Évora). Algarve has three hospitals offering
medical and surgical services similar to the Évora hospital (all belonging to
the Algarve Hospital Centre) and a rehabilitation hospital (Physical Medicine
and Rehabilitation Centre in São Brás de Alportel). Many of the hospitals
in the interior have suffered from a lack of resources compared with those
in Lisbon, Oporto and Coimbra. The investment programme in recent years
has concentrated heavily on these underserved regions and the hospitals have
benefited greatly from this fact, with many of the interior hospitals having now
better facilities than those in the coastal areas.
Since the mid-1990s, there have been major improvements and inaugurations
of medical facilities. In 1998, two hospitals were created in Santa Maria da
Feira and Cova da Beira (Centre region); in 1999 a hospital was opened in