Health Systems in Transition

Health systems in transition

Portugal

•

exclusions defined in insurance policies, which withdraw high treatment

costs or recurrent treatment of chronic diseases from insurance coverage;

•

delimitation of the scope of the guarantees, by defining limits in terms of

quantity of health care covered or maximum limits (ceiling) of coverage;

•

inclusion of a pre-authorization clause for certain medical expenses;

•

co-payments and deductibles;

•

definition of health care with larger grace periods;

•

attempt by insurers to cover only lower risk claims, including clauses

that define:

– exclusion of health care that may become necessary due to acquired

disease or the individual’s behaviour;

– premium update according to the individual’s age;

– age limits to insurance contract inaction or cessation;

– potential exclusion of some individuals.

Prevention of moral hazard and discrimination against individuals by

insurers suggest that if VHI (in current terms) was not complementary but

alternative to the NHS (i.e. replacing the NHS in health expenditure coverage

of Portuguese citizens), universal access to health care would be at stake

(ERS, 2015c).

3.5.4 Public policy

The ASF, the Consumers’ Institute (

Instituto do Consumidor

) and the

Portuguese Competition Authority (

Autoridade da Concorrência

) regulate the

private insurance market. There are no regulations in place to improve access

to the market, as can be found in other European countries.

Insurance premiums are deductible for fiscal purposes, but the limits are

low. For internal revenue service tax (personal income tax), 15% of health

expenses are deductible by any person or member of the household up to the

limit of €1000. Regarding corporations, insurance premiums can be accepted

as an expense as long as the insurance includes all workers, with a similar

coverage for all.