58 / 188
Health systems in transition
Portugal
58
3.3 Overview of the statutory financing system
3.3.1 Coverage
Breadth: who is covered?
All residents in Portugal are covered by the NHS, irrespective of their
socioeconomic, employment or legal status. The NHS is universal,
comprehensive and almost free at point of delivery (according to the Portuguese
Constitution, Article 64). The universal and comprehensive nature of the NHS
was defined at its inception (1979), and has been retained since then.
However, there are gaps in provision due to geographical imbalances,
as hospitals located outside great metropolitan areas like Lisbon, Oporto
and Coimbra do not provide for all medical specialties. However, the high
levels of investment in regional facilities outside Lisbon and Oporto in recent
years and the definition of regional systems contribute to attenuate these
geographical imbalances.
Since 2001, Portugal’s NHS services cannot refuse treatment based on
nationality, or legal or financial status of the migrant. Further, 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. It is expected that, given the universal and mostly free
health insurance coverage given by the Portuguese NHS, access by immigrants
to health care in Portugal is wider than in other European countries. However,
not only language, cultural differences and financial problems, but also service
constraints, remain major barriers that prevent immigrants from accessing
NHS services in Portugal (ERS, 2015a). Particularly, regarding immigrants
without legal status, information systems in the Portuguese NHS primary
care services do not allow referral to other levels of care or examinations and
drug prescriptions (ERS, 2015a). Some of these constraints have already been
explored in previous investigations in Portugal (Dias et al., 2011).
Scope: what is covered?
The NHS predominantly provides primary care and specialized hospital care.
Dental consultations, diagnostic services, renal dialysis and rehabilitation
are more commonly provided in the private sector (but with public funding
to a considerable extent). Typically, diagnostic services, renal dialysis and
rehabilitation are carried out under contractual arrangements with the NHS.
Most dental care is paid for OOP, as are many specialist consultations in private