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Health systems in transition
Portugal
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While many of the other measures implemented in Portugal during the
Economic and Financial Adjustment Programme in the pharmaceutical sector
aimed to lower prices, some also acted on volume; that is, the prescribing
patterns of doctors. This is usually a delicate matter and previously has not
been explicitly and directly addressed by the Portuguese authorities. The MoU
required a monitoring system that regularly provides information on both
the volume and value of prescribing by individual doctors (MoU, 2011). The
system has been in place since October 2011 as implemented by ACSS and it
is used to provide feedback to doctors. This has been made possible by another
MoU condition: the establishment of a mandatory electronic prescription
system for pharmaceuticals covered by the NHS (MoU, 2011). The system
has been operating since August 2011 (with a few temporary exceptions for
operational reasons). In addition, the MoU calls for the adoption of international
prescription guidelines in Portugal, to provide clear rules for more rational
prescribing patterns, which has been implemented since 2011–2012. These
guidelines aim to complement the feedback mechanism provided to doctors
on their own prescribing.
5.7 Rehabilitation/intermediate care
Medium-term care and rehabilitation services are provided by the RNCCI (see
section 5.8). These are inpatient services with their own physical space; they are
associated with an acute hospital for the provision of clinical care, rehabilitation
and psychosocial support due to a clinical situation resulting from recovery
from an acute condition or imbalance in a chronic pathological condition to
people with a temporary loss of autonomy, which is potentially recoverable.
These services aim to stabilize the clinical condition, assess and integrally
rehabilitate the patient. They consist of daily medical care, permanent nursing
care, physiotherapy and occupational therapy, prescription and administration
of pharmaceutical products, psychosocial support, hygiene, comfort, nutrition,
socialization and leisure. According to Decree-Law No. 101/2006, of 6 June
2006, which created the National Network of Long-term Care, the length of
stay in medium-term and rehabilitation units should be more than 30 and less
than 90 consecutive days for each admission; whereas long-term units should
provide care aimed at preventing or delaying the deterioration of clinical status,
promoting patients’ comfort and quality of life for a length of stay longer than
90 consecutive days.