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Health systems in transition
Portugal
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radiological facilities, both public and private, regarding planning, organization
and operation. Those facilities must then request radiological protection and
safety licensing from the DGH.
The legal framework regulating opening, modification and operation of
private health care units is established by the Decree-Law No. 279/2009, of
6 October 2009 (altered by the Decree-Law No. 164/2013, of 6 December 2013).
Since the 2013 legal update, and after publication of additional legislation,
radiology health care units follow a simplified licensing regimen.
In 2014, according to the new Legal Framework of Licensing (Decree-Law
No. 127/2014, of 22 August 2014), HRA became the only entity responsible for
licensing health care provision facilities.
Since 2012, the purchase of equipment, within the NHS, with a total value
greater than €100 000 must be previously authorized by the Ministry of Health.
This control mechanism was implemented to prevent NHS debt and delayed
payments to providers to grow out of control.
Equipment infrastructure
The latest equipment chart was published in 2014 with information referring to
2012 (Ministry of Health, 2014). It established national and regional ratios for
the major medical technologies for diagnostic imaging (including CT scanners
and MRI equipment). This new chart (the previous one was published in 1998)
allowed the Ministry of Health to identify the main gaps in, for example,
oncological responses (Ministry of Health, 2014). The chart concludes that
Portugal has insufficient equipment to meet health needs, particularly in nuclear
medicine and radio-oncology. For instance, instead of the 60 linear accelerators
(used in external radiotherapy treatments) needed, Portugal has only 45, 29 of
which are located in NHS units.
In 2013 there were five positron emission tomography scanners operating in
NHS facilities (one in Braga, one in Oporto, one in Lisbon and two in Coimbra).
Additionally there were seven positron emission tomography scanners operating
in private units: five in Lisbon and two in Oporto.
In 2013 the OECD average was 6.5 MRI units and 20.3 CT scanners per
million population (OECD, 2015b). Portugal is below the OECD average
regarding both MRI units (14.1) and CT scanners (24.4). However, considering
CT examinations per 1000 population, the country is above the OECD average
(Table 4.5).