Health Systems in Transition

Health systems in transition

Portugal

now concern with nurses’ unemployment and migration despite the fact that the

nurse ratio per doctor or per 1000 population is well below the OECD average

(see section 4.2.2).

Health ancillary technicians

The technological and scientific evolution of medical diagnostic and therapeutic

procedures has given ancillary professionals a more relevant role in health care

provision. As with doctors and nurses, these professions are salaried under a pay

scale that is not related to performance. A major revision of their professional

status was accomplished in 1999, along with a revised payment scale.

Members of management boards

Like all staff working in the NHS, members of the management boards of NHS

institutions and department heads are salaried employees, appointed by the

Minister of Health. Their remuneration is fixed, with no relation to attaining

production goals or any other form of performance evaluation. However, as

part of the health reform related to hospital management rules, a debate was

opened about the virtues of incentive-based payments to health professionals.

Dentists

Dentists in Portugal work in private practice and are paid on a fee-for-service

basis. Fees are privately determined, with the intervention of the Portuguese

Dental Association (

Ordem dos Médicos Dentistas

). Nowadays each private

practice sets the fees and has to post them at a visible location. Patients may

be partially reimbursed by their subsystem, professional insurance scheme or

private insurance scheme if dental care is included in the package of benefits.

There are very few salaried positions within the NHS related to dental care.

Only the more highly trained dentists (physicians who specialized in dental

care) are permitted to work in hospitals and paid on a salary basis by the NHS.

Pharmacists

Pharmacists in Portugal work in retail private pharmacies or in hospitals. They

can be either self-employed or receive a salary. The employer determines the

amount of salary paid. In the case of pharmacists working within the NHS, the

pharmacist is a civil servant, the salary is fixed and 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.