Health Systems in Transition - Portugal

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Health systems in transition Portugal 76
2010, all civil servants have seen their salaries being reduced due to severe cost
control measures taken by the government. This trend was reversed in 2016,
when cuts to salaries in the public sector were reversed. Currently, the highest
average monthly wage for a physician is €5063.40 for 40 hours/week of work,
and the lowest is €1931.20 (for residents doing post-graduate medical training) 5.
Particularly in small hospitals, where there are a small number of doctors and
on-call duties frequently arise, overtime can account for the majority of a
doctor’s overall income.
Professionals working in an FHU (model B) are paid by incentive
mechanisms related to their performance (see section 3.7.1, Payment of primary
care centres). Incentive mechanisms are linked to weighted units related to
specific activities of health monitoring and surveillance of patients at risk,
according to technical guidance provided by the DGH, on the following terms:
• surveillance of a woman of reproductive age, at family planning
consultation – one unit;
• surveillance of a pregnancy – eight units;
• surveillance of a child, in the first year of life, per year – seven units;
• surveillance of a child, in the second year of life, per year – three units;
• surveillance of a person with diabetes, per year – four units;
• surveillance of a person with high blood pressure, per year – two units.
Specific activities are annually contracted, whereas criteria for the
attribution of weighted units to the specific activities are defined by the DGH.
Nurses
The NHS employs nurses as civil servants. They are entitled to an annual fixed
salary. This fixed salary is linked to a civil service pay scale that rewards
people according to a matrix linking professional category and time of service
and is not related to performance. Public-sector work modalities for nurses
are: full-time (35–40 hours/week) and part-time (20 or 24 hours/week). As
with physicians, there are no data on the distribution of nurses across these
categories. Nurses also use the system as a way of upgrading their salary, due
to the ability to work extra hours because of the shortage of nurses. It is not
uncommon that nurses work in both public and private institutions, with a
“second employment” position, due to the scarcity of resources. However, recent
years have seen an increase in the supply of nurses, to the point where there is
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