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Health systems in transition
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of information on up-to-date practices in pharmaceuticals management and
dispensing; implementation of a global computerized information system
for the pharmacies; and collaboration with the government in projects and
campaigns in the public health domain.
2.1.10 Patient groups
Organizations specifically advocating for patients are active disease-based
advocacy groups, such as those devoted to diabetes, cancer, haemophilia,
hepatitis and HIV/AIDS. These groups are specifically focused on patients
and families affected by a particular condition, and promote the allocation of
resources for patients’ treatment and care in those particular disease groups, as
well as donations and awareness campaigns.
More recently, the project “More participation, better health” (
Mais
participação, melhor saúde
) was created with the aim of promoting the
participation and capacity building of representatives of people with and without
illness in policy and institutional decision-making in Portugal (GAT, 2016).
2.2 Decentralization and centralization
Formally, decentralization is a keyword of the NHS constitutional framework.
The Law on the Fundamental Principles of Health (1990) states that the NHS
is managed at the regional level, with responsibility for the health status of the
corresponding population, the coordination of the health services provision at
all levels, and the allocation of financial resources according to the population
needs. This is in line with the reform trends in many European countries, which
have regarded decentralization as an effective way to improve service delivery,
to better allocate resources according to needs, to involve the community in
health decision-making, and to reduce health inequities. In practice, however,
responsibility for planning and resource allocation in the Portuguese health
system, both to the level of the region and at the sub-regional level, has remained
highly centralized despite the establishment of the current five RHAs in 1993.
The Minister of Health appoints the directive body of each RHA. In theory,
the creation of the RHAs conferred financial responsibility: each RHA was
to be given a budget from which to provide health care services for a defined
population. However, in practice, the RHAs autonomy over budget setting and
spending is limited to primary care, because hospital budgets continue to be
defined and allocated by the central authority, which also appoints hospital
administration boards.