Health Systems in Transition

Health systems in transition

Portugal

Several insurance companies provide VHI. Private insurers are free to

choose their providers. The way they work is different from both NHS and

health subsystems health care provision. There are quite a few rules to conform

to in order to be accepted as a client of the insurer. Insurance companies

are under the jurisdiction of the Authority for Supervision of Insurance and

Pension Funds (

Autoridade de Supervisão de Seguros e Fundos de Pensões

ASF), which is responsible for the regulation and supervision of insurance,

reinsurance, pension funds and their management companies, and insurance

mediation, both from a prudential and a market conduct point of view (see

section 3.5).

2.4.2 Regulation and governance of provision

Organization

All hospitals belonging to the NHS are under the jurisdiction of the Ministry of

Health (see section 3.7.1,

Payment of hospitals

). Private sector hospitals, both

not-for-profit and for-profit, have their own management arrangements.

Since 2003, the majority of NHS hospitals have been given similar status to

those of a public-interest company (in what may be termed “autonomous public

hospitals”, whereby the government retains ultimate ownership but gives some

autonomy to hospital management –

Hospitais EPE

). This represents an attempt

to introduce a more corporate structure into hospital management, with the

expected effects on efficiency and cost-containment.

All hospitals are financed through contracts (

contratos-programa

), but

the

Hospitais EPE

concentrate many decision-making powers with relation

to capital, staff and negotiation of input prices, which are not present in the

traditional NHS-run hospitals. Among the new management rules,

Hospitais

EPE

may hire staff under individual labour contracts (instead of the public

administration regimen) and may set the performance-related payment

schedules of professionals. The use of incentive schemes is seen as a way to

counteract the existing tendency of “equal pay/least possible effort”. This

change generated competitive pressures in the labour market, more precisely

in the demand for physicians in the most sought after specialties, leading to

wage escalation. Several hospitals are also getting together to block purchase

pharmaceutical products and other clinical consumables, taking advantage of

the bargaining power resulting from larger acquisition volumes.

As noted before, since 2014 the HRA is responsible for licensing health care

providers. HRA’s competencies include deciding about issuing, maintaining or

revoking operating licenses from health care providers working both in private