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Health systems in transition
Portugal
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Within hospitals, the delegation of responsibility down the line of
management, allowing lower-level managers greater power to deploy resources
more efficiently, was the rationale for the creation of “responsibility centres”.
These centres were meant to group hospital services and units of an adequate
management dimension under criteria of homogeneity of production and
complementarities of objectives, with the aim to better coordinate medical
specialties, contain costs, and strengthen competition. To date, there are very few
responsibility centres, as their creation never gained momentum. The reforms
on hospital management led to neglect of these centres. No more responsibility
centres have been created, nor have the existing ones been eliminated.
Despite this, the creation of Public Enterprise Hospitals (
Hospitais EPE
)
(see section 2.4.2,
Organization
) from 2005 and the primary care reform
(see section 5.3) point to a high level of responsibility at the institution level.
The role of RHAs and other ministry authorities is more to supervise policy
implementation and assess results.
In the last 5 years, measures taken in the context of the Economic and
Financial Adjustment Programme agreed in May 2011 (see section 1.2), had the
effect of increasing central control, because some of the agreed targets required
financial, employment and other limits imposed from the centre.
2.3 Intersectorality
The current government recognizes that, “in order to obtain health gains, one
must intervene on the several health determinants in a systemic, systematic
and integrated way”, adding that “the integration of the health sector with
education, where ‘health in all policies’ should be a core strategy that will allow
to leverage and create the supporting frame for the sustainability of political
action” (Government of Portugal, 2015b). In its programme, the government
highlights policies to tackle poverty and exclusion, improve working conditions,
employment, food, transport, urban planning and leisure areas as fundamental
to improving the health of the population.
In 2012, the DGH launched nine priority health programmes, including
diabetes, cerebro-cardiovascular diseases, oncological diseases, mental
health, tobacco control, respiratory diseases, healthy nutrition, prevention
and control of antimicrobial resistance and infections, and HIV/AIDS (see
section 5.1). Those programmes set a number of intersectoral approaches,
namely partnerships with municipalities, schools and civil society, in order to