Health Systems in Transition

Health systems in transition

Portugal

In the private sector, the major health subsystems are: the health subsystem

for the employees of the historic telecommunications operator Portugal Telecom

(

Portugal Telecom Associação de Cuidados de Saúde

, PT-ACS), for postal

service employees at

Correios de Portugal

, and for banking and associated

insurance employees (

Serviços de Assistência Médico-Social

), set up by their

respective unions on a regional basis. There are also a few additional smaller

funds. Some of the funds are associated with and run by trade unions and

managed by boards of elected members.

Until 2013, the Ministry of Finance controlled the largest health subsystem,

ADSE, which was mandatory for all civil servants until 2009. Since 2009, civil

servants may easily opt out from ADSE. In 2015, ADSE was transferred to the

Ministry of Health (Decree-Law No. 152/2015, of 7 August 2015). However,

in 2017, ADSE was converted into a public institute with special regimen and

participated management (Decree-Law No. 7/2017, of 9 January 2017), and

it was renamed Institute for Protection and Assistance in Illness (

Instituto

de Protecção e Assistência na Doença

). ADSE is now under the indirect

administration of both the Ministry of Health and the Ministry of Finance.

Created in 1963, this subsystem covers more than 10% of the population, with

1.25 million enrolled beneficiaries in 2015 (ERS 2016c) (see section 3.6.1 for

more information on health subsystems).

Private health care providers mainly fulfil a supplementary role to the NHS

rather than providing a global alternative to it. Currently, the private sector

mainly provides diagnostic, therapeutic and dental services, as well as some

ambulatory consultations, rehabilitation and hospitalization.

2.1.7 Religious charities –

Misericórdias

Misericórdias

are independent non-profit-making institutions with a charitable

background. The Lisbon

Misericórdia

is an exception, because it is a public

enterprise with a board that is appointed by the Ministry of Labour, Solidarity

and Social Security rather than elected by members. Despite their historical role

as one of the main providers of health care services, currently these institutions

operate very few hospitals: a total of 15 hospitals distributed across the country,

but mostly concentrated in the North region (10). Most of the institutions are

now focused on long-term care provision, being the largest provider in the

National Network for Long-term Care (

Rede Nacional de Cuidados Continuados

Integrados

, RNCCI), both in number of units and capacity.