Health Systems in Transition - Portugal

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Health systems in transition Portugal 69
3.6 Other financing
3.6.1 Parallel health systems
The Portuguese health system is characterized by three co-existing and
overlapping systems: the universal NHS; the health subsystems, which are
special public and private insurance schemes for certain professions; and
private VHI.
Health subsystems are insurance schemes for which membership is based
on professional or occupational category. Hence, they can be divided into
public or private health subsystems, according to the employer’s nature (see
section 2.1.6). Health subsystems are normally financed through employer and
employee contributions, with the largest portion paid by the employer. Most
beneficiaries of public sector health subsystems, such as those covering civil
servants (e.g. ADSE), have contributed 3.5% of their gross salary since 2014
(ERS, 2016c). Private subsystems also receive mandatory contributions in a way
that closely matches the practice of public health subsystems. However, in the
private subsystems, contributions vary.
The main health subsystem is the ADSE for civil servants, covering
1.25 million beneficiaries as of 31 December 2015 (ERS, 2016c), whereas
private subsystems include Portugal Telecom Associação de Cuidados de
Saúde, for workers of Portugal Telecom, Serviços de Assistência Médico-Social
for workers of the banking sector, and Serviços Sociais da Caixa Geral de
Depósitos (Social Services of Caixa Geral de Depósitos) for workers of CGD
(the state-owned bank). These schemes have a wider network of contracted
providers than some private insurers.
The ADSE is administered by the Institute for Protection and Assistance
in Illness (see section 2.1.1). Its mission is to guarantee protection to public
administration workers regarding health promotion, disease prevention,
treatment and rehabilitation. Beneficiaries, like individuals insured by VHI,
have the option to use the network of contracted providers, or to simply
pay for a service in any provider without contract and later request partial
reimbursement of expenses. Access for health subsystems’ beneficiaries to the
NHS occurs under the same conditions as any NHS user. When referral from
the NHS to the network of private contracted providers occurs, beneficiaries
can choose to use a provider contracted with the NHS or one contracted with
their health subsystem.