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Health systems in transition
Portugal
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Box 3.2
Assessing coverage
The NHS has been able to provide a universal and comprehensive approach to citizens’ health
problems, in both primary and hospital care. The exception is dental care, which is mainly based
on private providers and funded by families.
Contracting with private providers has allowed the NHS, as funder, to meet the need of its users,
mainly in laboratory tests, imaging, renal dialysis and rehabilitation. However, waiting lists remain
a major problem regarding financial protection (seeking in the private sector the response that the
NHS is not able to provide), access and equity. Waiting lists might be a major explanation for the
magnitude of OOP payments in Portugal.
Despite the constant response of the NHS (meaning that utilization and the offer of services
has not decreased) in recent years (2010–2014), both OOP payments and private sector activity
have increased, in parallel with an increase in exemptions. This suggests that those with higher
disposable income might have turned to private health care providers due to unsatisfactory
responses from the NHS (e.g. waiting time).
3.3.2 Collection
General government budget
A budget for total NHS expenditure is established within the annual government
budget. Traditionally, this has been a soft budget. Actual health expenditure
usually exceeded the budget limits, sometimes requiring supplementary
budgets to be approved. Apart from direct transfers from the government
budget, the NHS raises its own revenue, mostly generated by hospitals. This
includes payments from private insurers (especially relevant for road traffic
and workplace accident victims), income from investments, donations, fines
and user charges.
Taxes, contributions or premiums pooled by a separate agency
The NHS is mainly financed by general taxes, which are not earmarked. Tax
revenue also funds the employer contributions for government and public sector
employees. The main tax fund sources are taxes on income (47% of total tax
revenue in 2014), followed by indirect taxes (42.3% of total tax revenue in 2014)
(INE, 2016a).