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Health systems in transition
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6.1.4 Long-term and palliative care
The RNCCI (
Rede Nacional de Cuidados Continuados Integrados
) was created
in 2006 together with a task force that coordinated it (see section 5.8). It filled
the gap of the increasing need for long-term care in the public sector. The
network provides three types of care through convalescence (recovery) units,
medium-term care and rehabilitation units, and long-term care units, with
different goals according to each type of unit. The resources available and the
payment systems are also different among these units.
The RNCCI has significantly expanded since its inception. Mostly, the
expansion of the network occurred through contracts with private facilities,
which increased the supply of long-term care beds (see section 5.8). Recent
changes introduced to the RNCCI include the integration of the coordination of
the public network of long-term care beds in the ACSS, from December 2012.
Additionally, the National Network of Palliative Care was created in 2012 under
the responsibility of the Ministry of Health. This network complements and
expands existing structures, such as those that already existed in the RNCCI.
The network is coordinated by a National Commission for Palliative Care in
close touch with regional and local structures, and aims to providing palliative
care to ill people, irrespective of their age and pathology, who are suffering due
to advanced disease (Law No. 52/2012, of 5 September 2012).
6.1.5 Primary and hospital care
Other major reforms have been undertaken in the hospital and primary health
care settings. In acute care, Portugal has pursued a number of reforms to
rationalize its hospital sector through the specialization and concentration of
hospital services. New management models and payment systems have been
introduced, with the transformation of public hospitals into public enterprises
(
Hospitais EPE
) (see section 2.1.1). To tackle the increased operational costs
of NHS hospitals, additional measures were taken, including the reduction
of overtime payment, restrictions to hiring new personnel, and restrictions
to external service contracting. Ambulatory surgery has been strongly
promoted in recent years, namely through incentives to hospitals, the creation
of infrastructures, benchmarking monitoring and price revision. The main
goal was to promote better resource allocation and increased efficiency
among NHS hospitals. The model of P-PPs was applied in some hospitals,
but no more P-PPs are being planned for the health sector (see section 4.1.1;
Investment funding
).