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Health systems in transition
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Portimão (Algarve); in 2000 and 2003 another three were opened in Vale de
Sousa (North region), Torres Novas and later Tomar (Centre region); and finally,
in 2004, another hospital in Santiago do Cacém (Alentejo) was opened. The use
of P-PPs for renewed infrastructures also took place, with the first one starting
to operate in April 2007 (São Brás de Alportel), and, more recently, hospitals
of Cascais (2009), Braga (2011), Vila Franca de Xira (2011) and Loures (2012).
Box 5.6
Assessing the appropriateness of care
The analysis of NHS users’ access to publicly funded hospital care identified unadjusted supply
considering the potential demand (ERS, 2011).
Regarding proximity, areas covered by hospitals are not adequate for the populations living in
municipalities of mainland Portugal, according to the reference of a 60-minute distance to the
hospitals. Results show inequalities in NHS users’ access and eventually a hospital distribution
out of step with the population distribution. In some regions, such as Alentejo and Algarve,
the populations may experience difficult access to hospital care, whereas in other regions, like
Lisbon and Oporto, there is an overlap of areas covered by hospitals. On the one hand, there are
approximately 200 000 people living more than 60 minutes away from a publicly funded hospital; on
the other hand, there is overlap in areas covered by hospitals providing the same level of health care.
Regarding capacity, there are regions with more than 500 physicians per 100 000 population, which
indicates a potential oversupply. Additionally, in some municipalities, an oversupply of hospital
specialties by hospitals providing the same level of health care was identified (ERS, 2011).
Primary care provision within the NHS comprises FHUs and PHCUs. More than 99% of people
on mainland Portugal live less than 30 minutes away from a primary care facility. In 2014, 87% of
NHS users were enrolled in a GP patient list; this proportion being highest in the North and the
lowest in Algarve. All NHS users enrolled in an FHU have a GP, but that does not happen with
NHS users enrolled in a PHCU (ERS, 2016a).
Analysing publicly funded health care provision in the private sector (private providers that have
contracts with the NHS), there is a fair access of the population to laboratory tests, with almost
100% of the population living less than 30 minutes away from a contracted provider (ERS, 2013c).
However, access to dialysis is poor, especially in Alentejo, Algarve and the Centre regions. Access
to physical medicine and rehabilitation is higher than to dialysis but lower than to laboratory tests
(ERS, 2013c). Alentejo is the region with the lowest access to physical medicine and rehabilitation,
with more than half of the population living more than 30 minutes away from a contracted provider
(ERS, 2013c). Alentejo and Algarve also have a lower access to radiology compared with the other
regions (ERS, 2013c).
The first point of contact within the public system is the GP in a primary
care unit (see section 5.3). The problem of lack of coordination between
hospitals and primary care centres and the large numbers of patients bypassing
the referral system has led to the development of local health units. These are
organizations of vertical integration comprising one or more hospitals and a