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Health systems in transition
Portugal
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ambulatory care. Theoretically, there are no services explicitly excluded from
NHS coverage. However, throughout Portugal, the NHS does not cover dental
care: it is neither provided nor funded by the NHS.
Since the creation of the NHS, dental care has been one of the areas
where public coverage is still very limited. That was emphasized in previous
analyses, which highlighted the exceptions to the formally comprehensive NHS
coverage, namely dental care, where private providers have a predominant role
(Simões, Barros & Pereira, 2007). According to the 4th National Health Survey
(2005/2006), approximately 92% of dental consultations
1
, and 60% of specialist
consultations (e.g. cardiology) took place in the private sector (INSA, 2007).
In 2008, given the need to ensure equitable lifelong dental care provision, the
National Programme for Oral Healthcare Promotion (
Programa Nacional para
a Promoção da Saúde Oral
) was extended to pregnant women and the elderly
who received social benefits. Those were identified as the most vulnerable
groups regarding dental care, and hence a dental pay cheque programme was
created to facilitate their access to dentists. Later, the National Programme
for Oral Healthcare Promotion was further extended to people living with
HIV/AIDS (in 2010), and those who needed early intervention due to oral cancer
(in 2014) (see section 2.5.2).
The role of private specialists has increased during the last decade (Campos &
Simões, 2014). This is due to both NHS shortages (with long waiting times) and
a tradition, from before the creation of the NHS, of direct access to physicians’
private offices. Overall, the scope of coverage in the NHS is comprehensive.
Depth: how much of benefit cost is covered?
User charges are in place for most NHS services, being most visible to the
population in emergency visits, GPs and specialists visits. While extensive
exemptions exist for user charges at service level, the depth of coverage is
lowest for pharmaceuticals. The current government has revised both values
and exemptions to user charges in 2016 (see section 3.4.1).
Concerning economic evaluation and consequent provision of coverage for
pharmaceutical expenses, in Portugal, as in other countries, pharmaceutical
products face a process of evaluation before they are included under the NHS
coverage. Each recent pharmaceutical available for sale in pharmacies is subject
to an economic evaluation (guidelines for this were enacted in 1998). In 2006,
the government extended the same guiding principles of economic evaluation
1
The remaining dental consultations that do not take place in the private sector (8%) correspond to stomatology
consultations in hospitals, which are classified as dental consultations.