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Health systems in transition
Portugal
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To reach those goals, the document included 34 measures comprising a wide
range of areas in the health system: financing of the NHS and public health
subsystems, pharmaceutical market and pharmacies sector, prescription and
monitoring of prescription, centralized purchasing and procurement, primary
care and hospital services, and cross-sectoral services.
The real impact of the measures implemented by the MoU when analysing
major indicators of health system performance is not fully understood because
it cannot be easily dissociated from the economic crisis. The comparison of
Portugal with the international context regarding resources allocated (health
expenditure) and outcomes (life expectancy at birth and at age 65 years) shows
that the Portuguese health system is among the most efficient in Europe.
Major health indicators are improving, and total health expenditure has been
controlled, mainly through cost-containment and price cuts.
In contrast, it seems that the balance between austerity measures and the
maintenance of the health status and access to health care is the result of a
decreased public share in total health expenditure. In fact, before the crisis,
the financial burden on Portuguese families was already significant, bearing
in mind the goal of universal coverage of the Portuguese NHS. Some recent
health policies aimed at tackling the Portuguese NHS problems seem to have
intensified this trend.
Since 2010, the amount spent on health care has decreased in both absolute
and relative terms, after a strong growth pattern observed in the previous
years. In the European context, public sources of spending as a percentage
of total health expenditure in Portugal (64.7%) are among the lowest in the
EU, whose average is 76.0%. Most private health expenditure is accounted
for by OOP spending, in the form of co-payments and direct payments made
by citizens for pharmaceuticals, examinations and outpatient consultations.
OOP payments in Portugal are estimated to be among the highest in the EU,
accounting for 26.8% of total health expenditure in 2014 and 27.6% in 2015
(provisional data).
In the pharmaceuticals market and pharmacies sector, retail prices have
significantly decreased since 2011, due to measures such as the revision of
distribution margins in consequence of changes in the countries included in
the International Reference Pricing. Expenditure on prescribed medicines sold
in pharmacies decreased by approximately 12% between 2011 and 2015. This
came as a consequence of a notable price cut in pharmaceuticals that was able
to counterbalance the effect of increased consumption on total expenditure and
public expenditure for pharmaceuticals.