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Health systems in transition
Portugal
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6.2 Future developments
The Government Programme (2015–2019) and the National Health Plan
2012–2020 are the main strategic documents for health policy. While the
National Health Plan provides a generic guidance to monitor health gains, the
Government Programme is the main reference for the practical implementation
of policy measures.
Despite some developments in recent years (see section 6.1), several
challenges remain in the Portuguese health system. One of the first challenges
is how to increase healthy life expectancy at age 65. While Portugal is in a
comfortable position regarding life expectancy at birth (see section 1.4),
health problems at age 65 are hampering life expectancy in the country. The
Government Programme foresees an integrated health promotion process that
encompasses all public policies influencing population health. This programme
is expected to involve several ministries and civil society partners.
An additional challenge is to achieve a balance between financial
sustainability and the possibility of expansion for the NHS. In fact, the high
health care spending and the unsatisfactory efficiency of the NHS was, for
some time, hampering the possibility of improvement in underserved fields
such as dental health, mental health or palliative care and general NHS quality.
The majority of costs in the health system are related to caring for people with
long-term chronic conditions. It has been argued that financial sustainability will
only be achieved through reducing the incidence of these diseases, developing
new models of health care provision for them and ensuring that evidence is
systematically applied everywhere and waste (i.e. system inefficiencies) is
reduced to a minimum (Crisp et al., 2014). The financial sustainability of the
health system will depend on political willingness to introduce health in all
policies, which has not been introduced yet, effective health promotion and
concerted actions by citizens, the society and health care professionals. The
next years will provide an answer to the question of whether recent changes
in budgetary procedures implemented across the public sector in Portugal will
be able to contain debt accumulation by NHS institutions (e.g. price reductions
across the NHS, particularly in payments to private providers).
Another challenge relates to the wages of health care workers in the public
sector. Although most of the wage cuts introduced in 2012 are currently being
reversed, the payment to health care workers in the NHS, particularly physicians,
is lower than in the private sector (not to mention other European countries).
Recent years saw a wave of emigration among health care workers in Portugal,
mainly nurses, and the challenge in the coming years for the NHS is to be able