Health Systems in Transition

Health systems in transition

Portugal

cost of some courses of medication (see section 5.6). Indirect methods of cost

sharing are also present, namely reference pricing for pharmaceutical products.

Finally, deductibles are present in some commercial health insurance contracts.

Cost sharing is a highly debated issue in Portugal. The different cost-sharing

instruments have different objectives. The (stated) objective for co-payments is

to contain and regulate demand for public services (the standard argument of

moral hazard control). This is visible, for example, in the smaller value paid by

patients if they choose to go to primary care centres instead of going to hospital

emergency departments for care. On the other hand, the role of coinsurance in

pharmaceutical products is not only to influence demand but also to shift the

financial burden to the users, given its relatively high value (see section 5.6).

The total value of co-payments in NHS hospitals accounted for 1.7% of

the total NHS expenditure in 2012, which represents a significant increase

from previous years: 0.74% in 2010 and 0.95% in 2011 (ERS, 2013a). The

above cost-sharing arrangements are accompanied by mechanisms designed

to protect vulnerable groups of the population. Exemptions from co-payments

are generous and include pregnant women, those aged 18 years or younger,

pensioners with low income, persons responsible for disabled young people,

socially and economically disadvantaged people, and patients with some

chronic conditions. In August 2016, there were 6 159 324 users exempted from

paying user charges (roughly 60% of the population)

3.4.2 Direct payments

Direct payments take place for those services not covered by statuary

pre-payment, including dental care and specialist consultations in private

ambulatory care. The patient pays transportation costs, except in special

circumstances, such as long-distance travel, or specific health conditions

(e.g. patients on dialysis), in which case costs are subsidized. Emergency care

transportation, on the other hand, is provided free of charge by INEM (see

section 5.5).

3.4.3 Informal payments

There is no detailed information on the role and magnitude of informal

payments. The general perception is that they play at most a minor role.