Health Systems in Transition

Health systems in transition

Portugal

3.7.2 Paying health workers

In 2012, the government extended public servants’ weekly hours from 35 to

40 hours with no change in salaries in order to increase the full-time equivalents

of civil servants. However, this decision was revoked in 2016 by the current

government (Law No. 18/2016, of 20 June 2016) as one of the measures to

reverse the main austerity measures taken by the previous centre-right-wing

coalition. This applied to the majority of care professionals excluding those with

a private-law contractual relationship with the state.

Doctors

All NHS doctors are salaried government employees. The fixed salary is

established according to a matrix linking professional category and duration

of service, independent of any productivity measure. In 2012, following

a governmental decision to guarantee a rational and more efficient use of

available resources and a better sustainability of the health system, the usual

level of employment for medical doctors was raised from 35 to 40 hours/week

(Decree-Law No. 266-D/2012, of 31 December 2012) without any change in

salary. Currently, there are three employment levels for doctors: full-time (but

not exclusive) (40 hours/week), full-time with exclusive NHS employment

(40 hours/week with no private practice allowed), and part-time (being

employed under the part-time contracts is not allowed for a head of service).

There are no data available on the proportion of physicians in each of the

three employment categories. There are currently no incentives, or mandatory

times, for underserved areas. Since 2002, there has been a progressive increase

in individual labour contracts, that is, the use of private management legal

rules for the admission of workers in the NHS (both doctors and other health

care professionals).

It is estimated that about half of the NHS salaried doctors also work in

the private sector and many independent doctors work under contract for the

NHS. The NHS, the health subsystems and private insurance negotiate fees

independently with doctors (i.e. with independent doctors working under

special contracts when there is a need for more personnel, such as emergency

cover during influenza outbreaks or summer). Fees charged to the NHS are

generally the lowest. Private fees are not regulated by the government but are

subject to a range of reference prices set by the Medical Association (

Ordem

dos Médicos

In general, doctors perceive their salaries as relatively low and therefore

feel justified in augmenting their income through private sector activity, for

which they are remunerated on the basis of fee-for-service payments. Since