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Health systems in transition
Portugal
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7.1.3 Stated objectives of the health system
Article 64 of the Portuguese Constitution states:
“The right to health protection
is fulfilled through a universal and comprehensive national health service
and, taking into consideration citizens’ economic and social conditions, tends
toward being free of charge”.
The goal of the health system is to protect the health of the population
living in Portugal. To achieve this goal, the government may act directly as a
provider of health care or contract with private providers. Health policies should
promote equality of access to health care for all citizens, irrespective of the
economic condition and geographic location, and should ensure equity in the
distribution of resources and use of health care services across the population
(Law No. 48/90, 24 August 1990, with changes introduced by Law No. 27/2002,
8 November 2002).
According to the National Health Plan and the Government Programme,
equality of access should be translated into the universal coverage of all NHS
users to GPs, which is still far from being achieved (see section 5.3). The
introduction of average guaranteed response times for hospital visits was
useful because it enabled the identification of units that respond later to the
demand for health care, but waiting times remain at very high levels. In surgical
interventions, the Integrated System to Manage the List of Patients Enrolled
for Surgery (
Sistema Integrado de Gestão de Inscritos para Cirurgia
) (see
section 5.4) allows the patient to choose another public or a private hospital
contracted with the NHS, when the clinically acceptable waiting time is reached.
In short, there is a considerable gap between the rights legally enshrined and
the effective exercise of those rights by the NHS users, especially regarding the
access to NHS units by patients. This was the main reason for the excessive
use of hospital emergency departments and, on the other hand, the significant
growth of private provision in terms of hospitalization, observed between 2011
and 2015.
7.2 Health system impact on population health
It is not possible to provide an estimate of improvements in health status that
can be attributed to the health system, making a distinction between alternative
sources of improvement (health care, public health, lifestyle changes, income,