33 / 188
Health systems in transition
Portugal
33
•
a study assessing the performance of the NHS local health units
(
Unidades Locais de Saúde
) in terms of access to health care, service
quality, production, efficiency, and economic and financial performance
(ERS, 2015e).
2.4.1 Regulation and governance of third-party payers
The RHAs play an essential role in the contracting of health care providers
to work with the NHS. They are responsible, together with ACSS, for setting
up (and paying for) contracts (i.e. the contracting of private sector providers
to provide NHS patients with specific health care services) and contracts
(
contratos-programa
) with the hospitals (based on cost history, utilization and
complexity variables; see section 3.7.1,
Payment of hospitals
). RHAs are also in
charge of negotiating and signing Public–Private Partnership (P-PPs) contracts.
These follow the procedure used in the contract that established the first public
hospital under private management, signed between the private operators and
an RHA.
The delivery of diagnostic and therapeutic services by private providers to
the NHS is an area that for several years has been of concern to Portuguese
authorities. The public procurement framework of such contracting by the
NHS that has been in place since the late 1980s was responsible for a lack of
competition within this subsector and for the substantial cost to the NHS for
such services (ERS, 2006). In fact no new private providers were allowed to
contract with the NHS for some time, so the NHS was subjected to the prices of
those already contracted. These conventions are responsible for almost 10% of
the NHS total costs, which makes it a key issue with respect to cost-containment.
To tackle this problem, in 2013 the government approved a new legal
framework for private services contracted by the NHS (Decree-Law
No. 139/2013, of 9 October 2013). According to this new framework, NHS
authorities can choose whether they contract by adhesion contracts or public
tenders, and this choice must be based on the potential competition in each
relevant market (i.e. public tenders for markets with substantial number of
potential competitors for contracts with the NHS, while contracting by adhering
to pre-determined conditions, particularly prices for services, for markets with
few competitors). The rationale for this measure is to make public procurement
more sensitive to market competition and as a result, to achieve lower prices.
Health subsystems manage the provision of NHS and private sector services
through their own “contracted health care providers”.