Health Systems in Transition - Portugal

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Health systems in transition Portugal 158
with public funding to a considerable extent. Diagnostic services, renal dialysis
and physiotherapy treatments are provided under contractual arrangements
with the NHS. Most dental care is paid for OOP (see section 5.12), as are many
specialist consultations in private ambulatory care. Theoretically, there are no
services explicitly excluded from NHS coverage, but, in general, throughout
Portugal, the NHS does not cover dental care: it is neither provided nor funded
by the NHS.
The role of the private sector has increased during the last decade, moving
from a supply model, mainly based in outpatient care and medical diagnostic
and treatment procedures, to investment in progressively more differentiated
health services, capable of competing in some areas with public health services
(Campos and Simões, 2014). This is due both to NHS shortages – with long
waiting times – and a tradition, from before the creation of the NHS, of direct
access to physicians’ private offices. Overall, the scope of coverage in the NHS
is comprehensive.
User charges are in place for most NHS services. Also, user charges are most
visible to the population in emergency visits, and visits to GPs and specialists.
However, the current government has revised both values and exemptions to
user charges in 2016 (see section 3.4.1).
The definition of average times in the health sector allows patients to know
the maximum response times for hospital care in NHS hospitals (available at
the NHS Portal . In emergency rooms, patients are subject to
screening upon arrival and are given a priority level corresponding to a colour
(according to the Manchester Triage): Immediate care – red; Very urgent –
orange (less than 60 minutes); Urgent – yellow (maximum 60 minutes);
Standard – green (maximum 120 minutes); Not urgent – blue (maximum
240 minutes).
Regarding primary care, between 2010 and 2014, the number of NHS users
on a GP patient list decreased by 2% at a national level, but that reduction was
more significant in the Lisbon and the Tagus Valley Region (ERS, 2016a). In
2014, 87% of all NHS users were included in a GP patient list. That proportion
was close to 100% in FHUs compared with PHCUs. Rates of utilization of
primary care consultations, given by the number of NHS users who had at
least a medical appointment in a year, are higher in FHUs. Also, between 2012
and 2014, average rates of utilization of nursing appointments, home medical
or nursing care, and family planning were also higher in FHUs. In contrast,
PHCUs have recorded longer waiting times for medical appointments with a
GP than FHUs, both for programmed and urgent appointments (ERS, 2016a).