65 / 188
Health systems in transition
Portugal
65
In March 2016, the existing exemptions for user charges were revised.
Firemen, blood donors and donors of live cells and tissues became totally
exempted from user charges in the NHS. Examinations performed in
day hospitals and emergency services (if referred by primary units, the
INEM or
Saúde 24
call centre) also became exempted. Finally, first outpatient
consultations referred by primary care units; emergency service visits referred
by primary care units, INEM or
Saúde 24
; and primary care visits referred by
Saúde 24
were also exempted for user charges (ACSS, 2016a).
Table 3.5
Values (in
€
) of user charges in the Portuguese NHS, 2011–2016
2011
2012
2013
2014
2015
2016
Emergency service
General emergency
a
9.60
20.00
20.60
20.65
20.60
18.00
Medical surgical emergency
8.60
17.50
18.00
18.05
18.00
16.00
Basic emergency
8.60
15.00
15.45
15.50
15.45
14.00
Outpatient service
Specialized consultation
4.60
7.50
7.75
7.75
7.75
7.00
Primary care consultation
2.25
5.00
5.00
5.00
5.00
4.50
Source
: Barros, 2012; SNS, 2016.
Notes
:
a
General emergency services (
Serviços de Urgência polivalente
) comprise all types of emergency services, including intensive
care and several specialties.
Currently, users in a situation of financial hardship (i.e. with an average
household monthly income ≤ 1.5 times the Index of Social Support; for more
details on household income definition, see corresponding legislation in
Ordinance No. 311-D/2011, of 27 December 2011), unemployed people, pregnant
and parturient women, blood donors, live donors of cells and tissues, refugees
and asylum seekers, firemen, people aged 18 years or under, and those belonging
to certain patient groups are exempted from user charges in all NHS institutions.
In April 2016, 6.1 million NHS users (roughly 60% of the population) were
exempted from any user charges, with 2.7 million (44%) being exempted due
to financial hardship.
Coinsurance, in which the user pays a fraction of the cost of the service,
is in place for pharmaceutical products covered by the NHS and for other
health insurance arrangements (subsystems and VHI). The coinsurance
on pharmaceuticals varies depending on the therapeutic value of the drug.
Pensioners pay a reduced rate and chronically ill patients are exempt from the