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Health systems in transition
Portugal
157
•
chronic obstructive pulmonary disease (31.7/100 000) in Portugal, both for
men (57.0/100 000) and women (15.4/100 000);
•
circulatory system diseases (230.8/100 000), for both men (276.4/100 000)
and women (194.0/100 000);
•
ischaemic heart diseases (71.1/100 00), for both men (107.0/100 000) and
women (43.1/100 000);
•
acute myocardial infarction (46.5/100 000), for both men (70.3/100 000)
and women (27.0/100 000).
Finally, Madeira recorded the highest SDR for respiratory diseases
(120.5/100 000) in Portugal, for both men (150.0/100 000) and women
(104.2/100 000), and the second highest SDR for alcohol abuse – 2.3 deaths per
100 000 population (INE, 2016c).
Despite the high constitutional commitment to social rights, the distribution
of social health determinants is not equitable, making Portugal the most
unequal country among the EU countries, which is reflected in the existence
of inequalities in health (Ferrinho et al., 2014). The main contributions to
health inequalities are disparities in income, education and physical activity.
Health inequalities remain one of the key challenges for the Portuguese NHS
in the future.
Political decisions to improve this situation are not yet visible. Other
inequalities are to a large extent dependent on the evolution of the country’s
economic and financial situation. The budget for the NHS has not significantly
increased since 2010, making the hiring of more health professionals to the NHS
difficult, which is one of the current problems of the NHS.
7.3 Access
All residents in Portugal are covered by the NHS, irrespective of their
socioeconomic, employment or legal status. As noted before, the NHS is
universal, comprehensive and almost free at the point of delivery. However,
there are gaps in provision due to geographical imbalances, as hospitals located
outside great metropolitan areas like Lisbon, Oporto and Coimbra do not
provide for all medical specialties.
The NHS predominantly provides primary care and acute general and
specialized hospital care. Dental care, diagnostic services, renal dialysis and
physiotherapy treatments are more commonly provided in the private sector, but