161 / 188
Health systems in transition
Portugal
161
7.4 Financial protection
The main source of funding is general taxation, which in Portugal is
slightly progressive due to progressive income taxation. The progressive
income tax system in Portugal turns out to be slightly regressive for health
care financing due to the high share of OOP payments along with a heavy
reliance on indirect taxes (see section 3.1). Further, OOP payments introduce a
regressive element.
OOP payments are one of the most important sources of financing of the
Portuguese health system: 27.6% of total health expenditure in 2015 (INE,
2016f) (see section 3.2). In recent years, several countries, including Portugal,
have tried to increase patients’ OOP payments to ensure financial sustainability
of the NHS. Patients pay a large share of pharmaceutical expenditure, due to
the low co-payment rates by the NHS, few patients exempted from payment,
and the high level of pharmaceutical consumption in Portugal (Simões, Barros
& Pereira, 2007).
Box 7.1
Universal health coverage
Universal health coverage is enforced by the Constitution of the Portuguese Republic (1976) and
was also inscribed in the Law, which enacted the National Health Service (1979).
The Portuguese NHS is indeed universal, with the exception of dental care, which is provided
through the private sector (through OOP payment or VHI). This scenario was slightly improved
with the creation of dental pay cheques (2008), which allows school-aged children, pregnant women
and the elderly who receive social benefits to have free access to dental care. The government has
recently announced the intention of providing dental care in some primary care settings.
The Portuguese NHS has been able to provide quality health care irrespective of social and
economic status, ensuring that those in need are able to use the services. The NHS makes
efforts to ensure an equitable access to health care (e.g. exemptions in user charges). Thus, those
experiencing financial problems and/or belonging to certain patient groups are exempted from
paying user charges and there are also benefits regarding pharmaceuticals co-insurance by the
NHS (see section 3.4.1).
The primary health care and hospital network scattered all over the country is a condition for
universal coverage and for the improvement of the delivery of health care services. However,
equity in geographic coverage of hospital care remains a challenge for the upcoming years.