Health Systems in Transition

Health systems in transition

Portugal

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environmental factors). Few studies have tried to link health care interventions

and health status improvements in Portugal. Establishing evidence on this issue

remains a challenge for health policy-makers and analysts in Portugal.

Mortality amenable to health care – defined as causes of death that should

not occur in the presence of effective and timely health care – improved

between 2000 and 2014 (Fig. 7.1a). Portugal shows similar results to the

United Kingdom, and amenable mortality is below the EU average. However,

Portugal still records higher rates of amenable mortality than France, Spain

and Italy (Fig. 7.1a). Regarding preventable mortality, Portugal is also below

the EU average and records lower rates than France, Italy, Spain, the United

Kingdom and Latvia (Fig. 7.1b).

The OECD health care quality indicators show a mixed picture of health

outcomes and health care delivery in Portugal: avoidable admissions and

obstetric trauma are low, but mortality following acute myocardial infarction

and after admission for ischaemic stroke are high (OECD, 2015a). In the

case of fatality after admission for acute myocardial infarction, Portugal has

a marginally higher rate than the OECD average, at 8.4 per 100 admissions

(over 45 years of age) compared with 7.9 for the OECD (2013 data) (OECD,

2015a). Case fatality after admission for ischaemic stroke is higher in Portugal

than the OECD average; in 2011, case fatality per 100 admissions was 10.5

in Portugal, compared with 8.5 across the OECD (OECD, 2015a). Low rates

of obstetric trauma reflect positively on care quality in Portugal, but rates of

surgical complication show a mixed picture: there is good performance on

postoperative pulmonary embolism or deep vein thrombosis in adults, but for

postoperative sepsis Portugal shows poor performance compared with the

OECD average (OECD, 2015a). Additionally, avoidable hospital admissions

for asthma, chronic obstructive pulmonary disease and diabetes in Portugal are

among the lowest in the OECD (OECD, 2015a), which suggests good quality of

primary care in Portugal.

Some health determinants are hampering the improvement of health

outcomes in Portugal, such as the persistence of some structural fragilities

in public social policies, or the negative impact of the economic crisis on

the income of families and, consequently, on their health status (Ferrinho

et al., 2014).

EU countries follow a number of different approaches with regards to the

prevention and early diagnosis of cervical cancer. WHO recommends HPV

vaccinations as part of national immunization programmes primarily to

girls aged 9–13 years. The Portuguese National Immunization Programme