Health Systems in Transition

Health systems in transition

Portugal

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with real-time counting or the number of consultations in the several services

provided by the NHS. This area seems to be crucial to improving the NHS’s

accountability to citizens.

Accountability in the Portuguese health system relies on other institutions.

First, the Court of Auditors, which is the state’s supreme body for external

control of public finance. The Court of Auditors verifies if public funds are

properly managed according to the law and the principles of efficacy, efficiency

and effectiveness. This Court monitors and assesses relevant programmes and

projects that are publicly funded, as well as privatizations, and identifies those

responsible for managing public funds.

The parliament is responsible for passing the fundamental laws of the

Republic, scrutinizing compliance with the Constitution and the laws, and

monitoring the activity of the government and the public administration. The

Health Committee, comprising members of parliament from several political

parties, supervises sectors under the responsibility of the Ministry of Health,

monitoring the NHS and health policies.

At regional and institutional levels, accountability in the health system is

through a hierarchical network of services, with little citizen participation.

However, patients’ involvement in clinical decisions is organized differently.

Patients’ rights and duties are established in the Framework Health Law (

Lei de

Bases da Saúde

), in the Penal Code and other diplomas, and are assembled in the

Patient Charter (

Carta dos Direitos e Deveres dos Doentes

) (see section 2.5.3).

This Charter has no binding status but summarizes in a comprehensive way the

core features of a patient–doctor relationship.

Patients have the right to free and informed consent, to informational

self-determination, to access their own clinical information, to have their

privacy respected and to make suggestions and complaints. The Patient’s

Cabinet links patients and services and mitigates the eventual conflict dynamics.

In recent years, the increasing importance of the HRA is shown by the new

powers of this body, namely the supervision of all complaints made by patients,

the actions taken by health care providers, and the sanctions for any infraction.