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Health systems in transition
Portugal
4
Portuguese immigration policy is currently guided by Law No. 29/2012
of 9 August 2012, which establishes that immigrants have the same access
to the health system as Portuguese citizens (see section 3.3.1,
Breadth: who
is covered?
).
The government does not gather data on ethnicity. The latest information
on religion is provided by the 2011 Census, where 81.0% of residents aged
15 years or older identified themselves as Roman Catholics, and only 6.8%
declared themselves atheist (8.3% of respondents did not answer that question).
Muslim (0.2%) and Jewish (0.03%) communities are small (INE, 2011).
According to Eurostat (2016a), Portugal had the lowest fertility rate among
the European Union (EU) Member States as of 2013 (1.2 total fertility rate
compared with an estimated rate of 1.5 in the EU). Increasing life expectancy
(from 75.3 years in 1995 to 81.3 years in 2014) (see section 1.4), the decline in
fertility rates and the decrease of those aged 15–64 years (see Table 1.1), are
causing a “double ageing” effect in Portugal. Further, the population in Portugal
has been declining since 2010, mainly as a result of increased emigration and
decreased immigration (INE, 2014).
1.2 Economic context
The international financial crisis that started in 2008 had a major impact
in Europe, and Portugal was no exception. Following several years of weak
economic growth (average gross domestic product (GDP) growth of 0.8%
between 2001 and 2010), the Portuguese economy experienced recession
in 2009, 2011 and 2012 (Perelman, Felix & Santana, 2015). The economic
slowdown was coupled with a steady rise in unemployment and by a public
debt crisis. The economic downturn and the turmoil that followed Greek and
Irish bailouts led to increased difficulty in Portugal accessing the financial
markets. In this context, Portugal was unable to re-finance its debt (both
public and private), which led Portugal to request financial assistance from
the EU, the European Central Bank and the International Monetary Fund
(Maresso et al., 2014). An Economic and Financial Adjustment Programme
was agreed between these three international institutions and the Portuguese
government in May 2011 by signing a Memorandum of Understanding (MoU)
(MoU, 2011; Augusto, 2012), in exchange for a loan of €78 billion. The MoU
defined several policy measures to be adopted by the Portuguese government
for the period 2011–2014, including: a range of austerity requirements, including