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Health systems in transition
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number of primary care centres, based partly on geographical proximity and
partly on the balance of specialties and availability of an emergency department.
However, local health units did not achieve all the expected improvements
in coordination and did not fulfil the aim of integrating, coordinating and
facilitating continuity of care.
Currently, there are eight local health units. This process of vertical
integration of health care began in Matosinhos (1999) but only 8 years later a
new local health unit was created – North Alentejo/Portalegre (2007). Local
health units in Northern Minho/Viana do Castelo, Southern Alentejo/Beja and
Guarda were created in 2008, followed by Castelo Branco (2009), Northeast/
Bragança (2011) and Coastal Alentejo/Santiago do Cacém (2012). According to
an analysis carried out by HRA, there is no evidence of significant performance
improvements after the integration of health care units in local health units
(ERS, 2015e).
Box 5.7
Patient evaluations of the care they receive
Following the National Strategy for Health Quality (Ministerial Dispatch No. 14223/2009, of
24 June 2009), where regular monitoring of NHS users’ satisfaction is a key component, the DGH
conducted the first public opinion survey, among 2300 interviews, to know the level of satisfaction
of NHS users with the services and the care provided.
Overall, 91% of the population felt “well served” by health care providers and 74% consider
the health problem that led them to seek care was resolved (DGS, 2015c). In the year before the
interview, most of the population (75%) went to a public facility, with 56% seeking an NHS
primary care centre and 19% an NHS hospital. The majority (87.4%) of respondents were satisfied
with the length of time of the medical consultation. Around 89% considered the doctor to have
given them the opportunity to pose questions and 94% stated that indications given by doctors
were clear. Finally, 87% of respondents thought that the doctor involved them in the decisions
about their health care and treatments (DGS, 2015c).
Monitoring NHS users’ satisfaction is also performed regularly in several FHUs. All ACES have
special cabinets to receive patients’ complaints and praises but no regular monitoring of patient
satisfaction take place in a comprehensive way in all units, meaning that, within the same ACES,
some FHUs regularly conduct surveys and other units do not.
Regarding hospital care, the latest survey conducted by the Ministry of Health was in 2009
(ACSS, 2009). Results of that study found the highest levels of satisfaction with doctors and
nurses in outpatient consultations, inpatient care and emergency services, while the lowest levels
of satisfaction were recorded regarding complaints process, waiting times (outpatient consultations
and emergency services) and food (inpatient care).