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Health systems in transition
Portugal
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Following the Dispatch No. 3250/2014, of 27 February 2014, a Task Force,
coordinated by the ACSS, assembled relevant information to assess mental care
provision and current needs. Available data show major red flags regarding
inpatient beds (four beds for adults per 25 000 population) and rehabilitation
units (152 beds, of which 94 at hospitals, and an additional 209 places in joint
response with the social sector) (DGS, 2015d). Like most health care resources
in Portugal, mental care provision is mostly in coastal areas, leaving the
interior population underserved: Alentejo (1.81) and Algarve (1.51) have a lower
ratio than the national ratio of 2.6 psychiatrists for 75 000 in public hospitals.
Regarding clinical psychologists, national average is 1 per 50 000 population,
the same as Alentejo and Algarve (ERS, 2015d). Professionals and resources
are mostly concentrated in the Greater Lisbon area.
5.12 Dental care
The publicly funded oral care system in Portugal is not comprehensive. There
are very few NHS dental care professionals in this sector, so people normally
use the private sector (see section 5.2). There has been an increase in financing
for dental care projects aimed at school populations, which has been associated
with an increase in children without tooth decay: from 33% in 2000 to 54% in
2013 (DGS, 2015a).
Some dentists contract with one or more health subsystems or VHI. Each
plan defines its own list of eligible treatments and fees. Those dentists not
under contract may provide care to patients covered by the plans; patients pay
directly and are then partially reimbursed by the scheme. Dental hygienists also
provide dental care, although this must be carried out under the direction of a
dentist. In Portugal, dentists are self-employed and their activity is regulated
by the Dentists Association.
To reduce inequalities in access to dental care, in 2008 the government
created the dental pay cheque, targeting children, pregnant women, elderly who
receive social benefits, and certain patient groups (see sections 2.5.2 and 3.3.1,
Scope: what is covered?
). Since 2014, the National Programme for Oral Health
Promotion has issued dental pay cheques to cover early interventions aimed to
prevent oral cancer.