Health Systems in Transition

Health systems in transition

Portugal

Box 4.1

Assessing the geographic distribution of health resources

As noted before (Box 1.1), there are a number of health inequalities in Portugal, such as geographic

barriers that limit equal access to health care. The distribution of health resources in Portugal is

not even across different regions and, inside regions, across the municipalities (Santos, 2012).

For instance, municipalities with a higher ageing index [the relation between older (64 years or

older) and younger (less than 14 years old) populations] have a lower ratio of physicians per

1000 population (Santos, 2012). Actually, the distribution of health resources does not seem to take

into consideration the characteristics of the population: there is no correlation between variables

such as physicians, beds, nurses and primary care units, and ageing index. Hence, municipalities

with a higher ageing index are not those concentrating more resources (Santos, 2012), resulting

in limited access to health care from those populations. There is a dichotomy rural/urban and

coast/interior, where municipalities with higher ageing index are concentrated in rural areas

in the interior. Although those municipalities are not very densely populated, since the interior

is desertified, those populations have higher health needs and seem to have difficult access to

health care.

These findings are supported by an analysis from 2007, which concluded that access to primary

care is less easy in the districts of Vila Real and Bragança (North Region – interior), and Viseu

(Centre Region – interior), whereas the districts of Faro (Algarve – coast), Coimbra (Centre

Region – coast) and Castelo Branco (Centre Region – interior) have the easiest access (ERS, 2010).

Nevertheless, the same study found that only 0.03% of the population lives more than 30 minutes

away from a primary care facility (ERS, 2010).

A more recent study from the HRA identified regions where the population experienced barriers

in accessing hospital care – particularly in Alentejo and Algarve – while other regions have a

potentially redundant hospital supply, for example where hospitals offering the same services

co-exist (ERS, 2011).

4.1.3 Medical equipment

Regulation of medical devices and aids

Decree-Law No. 95/1995, of 9 May 1995, established the procedures to be

followed in order to install heavy medical equipment in both public and private

health care facilities (i.e. medical equipment used for digital angiography,

external radiotherapy, brachytherapy, positron emission tomography, gamma

chambers, radiosurgery). The Ministry of Health, following programming and

spatial distribution criteria established by Government decision (Resolution

of the Council of Ministers No. 61/1995, of 28 June 1995), is responsible for

authorizing the installation of heavy medical equipment.

Decree-Law No. 180/2002, of 8 August 2002, establishes the rules for health

protection of people against ionizing radiation through medical exposure. The

same legislation defines acceptability requirements that must be followed by