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Health systems in transition
Portugal
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7.5 Health system efficiency
7.5.1 Allocative efficiency
Financial resources directed towards health care reached 9.5% of the GDP
in 2014, which puts Portugal in line with the EU average (see section 3.1).
Until 2010, there has been a steady growth in public health expenditure, with
private expenditure remaining relatively constant. Since 2010, public spending
has declined, whereas private expenditure has increased (see Table 3.3 in
section 3.2).
Taking the 2017 Government Budget as an example to illustrate the resource
allocation in the NHS, hospital care accounts for approximately 53% of the
NHS budget, while primary care receives 42% of the resources (Ministry of
Health, 2016).
The process of resource allocation in Portugal is moving away from history-
based allocation of funds towards an approach close to needs-based allocation.
This is the case for primary care, especially since 2012. Hospital care is moving
towards a contract-based approach, where explicit targets for “production” are
set and the corresponding payment is specified. Whenever the levels of activity
define the approximate health care needs of the population, the system moves
closer to a needs-based approach.
Recent years have shown a movement towards the correction of some
imbalances regarding human resources for health in Portugal. Previously
characterized by a big emphasis on specialist hospital care, relative scarcity of
physicians and low productivity, human resources planning is now focused on
increasing the number of GPs in order to scale-up primary care and alleviate
hospitals. The government introduced changes to the policy regarding vacancies
for postgraduate medical training for different specialties in NHS institutions.
This has been implemented progressively, with vacancies for GP training
increasing every year.
Priorities and health strategies are foreseen in the National Health Plan
(DGS, 2015b). Governments have requested independent studies on many
health policy matters to the HRA: in 2015/2016 studies were carried out on
context-related costs in the health sector; performance of local health units;
health insurance; access to health care by immigrants; access and quality in
mental care; access, quality and competition in continued and palliative care;