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Health systems in transition
Portugal
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Another recent change regarding health promotion was the termination
in 2012 of the four national vertical programmes on HIV/AIDS, oncological
diseases, cardiovascular diseases and mental health, which were replaced with
priority health programmes. Those resulted from the reorganization of the
four existing national vertical programmes as mentioned above and existing
initiatives on respiratory diseases, tobacco control, healthy nutrition, control
of antimicrobial resistance and diabetes. The goal was to prioritize the main
causes of mortality and morbidity in Portugal, as well as the important risk
factors that are prevalent among the population, such as overweight, smoking
and sedentary lifestyle (see section 1.4). Each priority health programme is
organized in accordance with the national health strategies, as included in the
National Health Plan, and has a 4-year term. In 2016, the length of programmes
was extended (2016–2020) and two more programmes were added: viral
hepatitis and physical activity (Dispatch No. 6401/2016, of 16 May 2016). The
new Programme for Physical Activity aims to promote healthy lifestyles and
tackle sedentary lifestyle, whereas the new Programme for Viral Hepatitis
aspires to develop hepatitis prevention and control strategies, scale-up best
practices for hepatitis C management, particularly among patients in prison,
and promote hepatitis monitoring and surveillance (see section 5.1).
6.1.3 Pharmaceutical market
Among the reforms implemented in Portugal since 2011, the pharmaceutical
sector has seen significant changes following shifts towards the generic market
and strengthening of procurement processes. Main reforms, which were linked
to the MoU, include changes to the structure of distribution margins, the
promotion of generic drugs, the use of clinical guidelines by physicians, and
the redefinition of the international referencing rules that establish prices of
new pharmaceutical products.
As a result, public pharmaceutical expenditure in ambulatory care decreased
by approximately 12% between 2011 and 2014. Overall, there was a price
reduction of drugs that counterbalanced the increasing consumption in that
period, with the decrease on the overall pharmaceutical expenditure achieved by
price reductions rather than reduced access to drugs or reduced re-imbursement
from the NHS (Barros, 2015).