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Health systems in transition
Portugal
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approximately 90% of a household’s OOP payments on health care. Most
dental care is paid OOP, as are many specialist consultations in private
ambulatory care.
3.4.1 Cost sharing (user charges)
Cost sharing is part of both the NHS and private financing arrangements. All
three forms of cost sharing are present in the NHS; the most common are
co-payments (or user charges), defined as a fixed amount charged for a service;
these exist in most public health care services (see Table 3.4).
Table 3.4
User charges for health services, 2016
Health service
Type of user charge in place
Exemptions and/or reduced rates
GP visit
Co-payment
Citizens with insufficient means,
unemployed people, pregnant and
parturient women, blood donors, live
donors of cells and tissues, refugees and
asylum seekers, firemen, people
≤
18 years,
and those belonging to certain patient
groups are exempt from user charges in
all NHS institutions
Primary care
Co-payment
Outpatient specialist visit
Co-payment
Emergency visits
Co-payment
Outpatient prescription drugs
Coinsurance, varies depending
on therapeutic value
Inpatient stay
None
a
Dental care
OOP payment
Dental pay cheques target elderly receiving
social benefits, pregnant women,
school-aged children, and some patient
groups (e.g. HIV/AIDS)
Medical devices
OOP payment
Source
: Authors’ elaboration.
Notes
:
a
Co-payment for inpatient stay was removed in 2009. There is no cap in OOP payments.
The values set for co-payments are typically small, when compared to
the cost of the service. For example, the co-payment for an emergency visit
currently ranges from €14 (in primary health care units) to €18 (in hospitals),
while the average cost of an episode ranges from €36 (for a basic emergency at a
primary health care unit) to €112 (in a general emergency service in a hospital),
according to the values published by the government (Ordinance (
Portaria
)
No. 234/2015, of 7 August 2015). There is no annual ceiling on co-payments.
Also in 2016, the values for user charges in the NHS were reduced for the
first time (Table 3.5) and the overall cap per episode of care was redefined
to €40 (previously €50) (Ordinance No. 64-C/2016, of 31 March 2016).