Health Systems in Transition - Portugal

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Health systems in transition Portugal 71
added value, including: improving health and reducing health inequalities,
encouraging innovation, increasing the sustainability of health systems, and
protecting against serious cross-border health threats.
3.6.3 Other sources of financing
Mutual funds
Approximately 650 000 people4 (6.3% of the population) are covered by
mutual funds, which are funded through voluntary contributions. They are
non-profit-making organizations that provide limited cover for consultations,
pharmaceuticals and, more rarely, some inpatient care. They do not exclusively
provide health benefits to associates so it is difficult to calculate the health
component of the contributions.
Long-term care
Long-term care has been neglected in terms of public sector involvement until
recently. Traditionally, Misericórdias and other non-governmental organizations
have provided long-term care. The NHS has paid some of the care they provided.
In 2006, given the population’s need for public sector involvement in long-term
care, a network of long-term care providers (RNCCI) was set up mainly in
private institutions (largely non-profit-making) (see section 5.8). The financial
responsibility of the public sector is shared between the Ministry of Health and
the Ministry of Labour, Solidarity and Social Security.
3.7 Payment mechanisms
The main provider groups and corresponding payment methods are shown in
Table 3.6.
Salary is the dominant method of provider payment in Portugal, particularly
for primary care and hospitals. In FHUs, besides salary, there are incentive
mechanisms based on performance (see section 3.7.1, Payment of primary
care centres). The Ministry of Health is the main funder of public hospitals,
considering not only historical expenditure but also DRGs.
In the private sector, in both ambulatory and hospital care, patients
make direct payments (OOP payments), with or without reimbursement or
co-payments by social health insurance or voluntary health insurance (VHI).
The same payment mechanisms apply to visits to dentists.
4