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Health systems in transition
Portugal
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4.1 Physical resources
4.1.1 Capital stock and investments
Current capital stock
In 2014, Portugal had 225 hospitals, 113 of which belonged to the NHS, five
military or prisoner hospitals, and 107 private hospitals, with a total capacity
of 34 522 beds (INE, 2016d). Almost half of the private hospitals belong to
for-profit organizations.
Misericórdias
currently operate hospitals and facilities
in the areas of rehabilitation, long-term care and residential care for older people,
people with disabilities and people with chronic illness (see section 2.1).
Trends in hospital numbers have been similar to those in other European
countries. There has been a significant decrease in the number of public
hospitals over the decades, from 634 in 1970 to 113 in 2014 (82% decrease).
This effect is possibly due to mergers in recent years between public sector
hospitals, and the closure of psychiatric hospitals. Over the last few years there
have been progressive improvements of some older infrastructures and new
hospitals have opened to replace old ones (see section 5.4).
Regulation of capital investment
Capital investments in health care are determined at central level by the Ministry
of Health. Equity in the geographic distribution of health care facilities is often
a point of contention (ERS, 2015b), although for the external observer, it is
unclear how such considerations are actually included in the process, alongside
the demands from local representatives of the population.
Investment funding
Since the beginning of this century, one of the government’s objectives has been
to improve the health care providing capacity of the NHS while guaranteeing
more value for money, by associating private entities in the sphere of public
responsibility to build, maintain and operate health facilities, under P-PPs.
This is reflected in the Programme from the XV Constitutional Government
(2002–2004) (Republic of Portugal, 2016). In the Programme from the current
government (XXI Constitutional Government), the need to promote external
and independent evaluation of P-PPs is highlighted, to technically support the
political decisions in this regard. From a financial point of view, the transfer of
financial risk investment from the government to the private operators through
P-PPs alleviates the former from the initial investment burden, which would be
otherwise excessive considering the financial constraints of the public sector.
Objections have been raised in some political (and technical) sectors concerning
the long-term consequences of this option. The model draws heavily on the