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coverage of the emergency network; access to health information; comparison
of FHU and PHCU; the restructuring of the ADSE; and the evaluation of P-PPs
in the health sector.
7.5.2 Technical efficiency
The recent evolution of the Portuguese health system suggests that improvements
have been made in terms of providing value for money. In particular, health
gains and increased activity in the NHS were obtained without adding extra
resources, indicating both an improvement in value for money provided and
that large inefficiencies were (and still are) present in the system. Increases
in productivity, measured by a higher growth in activity than in expenditure,
have been present over recent years, and were the aim of the Economic and
Financial Adjustment Programme. Overall, the system became cheaper (due
to cuts in spending) and more productive (due to increased working hours
and contracting with institutions). However, this type of evolution has natural
limitations, and in the near future productivity gains will most likely entail an
increase in spending, as opportunities for waste reduction become exhausted.
There is still much room for further efficiency gains in health care delivery
in Portugal, namely through the scale-up of health technology to improve both
the system’s quality and monitoring (see section 7.1).
Technical efficiency is to be further enhanced by the changes in the payment
mechanisms set for providers, even within the NHS but changes are taking place
slowly. Performance-related pay is currently being implemented in primary care
(for the model B FHUs) and prospective budgets (
contratos programa
) are being
used for hospital care. In both cases, the way in which providers are paid seems
to have some bearing on their efficiency level: model B FHUs and hospitals are
paid based on their performance; hence, theoretically, the more efficient they
are, the more money they get. Overall, FHUs, particularly those belonging to
the B model, are more efficient than PHCUs. That efficiency might be related
to the incentive mechanisms to health workers in those units, which do not exist
at the PHCUs. Regarding recent mergers, the literature suggests that there are
economies of scale and scope to explore, but only mergers of relatively small
and similar hospitals were successful (Azevedo & Mateus, 2014).