Health Systems in Transition

Health systems in transition

Portugal

cooperation with the media, schools, sports organizations and local authorities.

However, overall, the role of municipalities in the Portuguese health system

is rather marginal. The involvement of the municipalities in health promotion

programmes is limited to a few specific projects, namely child oral health,

environmental health and healthy behaviours.

2.1.6 Health subsystems

Almost four decades after the inception of the NHS in Portugal, the historical

remnants of the pre-existing social welfare system still persist in the form

of health insurance schemes for which membership is based on professional

or occupational category. These are often referred to as health subsystems

(

subsistemas de saúde

). In addition to the health insurance coverage provided by

the NHS, approximately 25% of the population is covered by a health subsystem

or VHI. More precisely, approximately 16% of the population are covered by a

health subsystem (ERS, 2016c), and in 2015 more than 2.7 million individuals

(around 25.8% of the population) were covered by individual or group private

health insurance (ASF, 2016). Health care is provided either directly or by

contract with private or public providers (and in some cases by a combination

of both). Access is generally limited to members of a specific profession and

their families.

In 2005, a number of subsystems operating in the public sector were integrated

into the main subsystem, the ADSE (

Assistência à Doença dos Servidores do

Estado

), for civil servants. Therefore, the benefits are now standardized across

the health subsystems. Before 2005 the separate subsystems included:

•

SSMJ (

Serviços Sociais do Ministério da Justiça

), for employees of the

Ministry of Justice;

•

ADMA (

Assistência na Doença aos Militares da Armada

), for the Navy;

•

ADME (

Assistência na Doença aos Militares do Exército

), for the Army;

•

ADFA (

Assistência na Doença aos Militares da Força Aérea

), for the

Air Force;

•

SAD-PSP (

Serviço de Assistência na Doença da Polícia de Segurança

Pública

), for police officers;

•

SAD-GNR (

Serviço de Assistência na Doença à GNR

), for Officers of

the National Republican Guard.