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Health systems in transition
Portugal
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Box 4.2
Evaluating the geographic distribution of health workers
Like most populations, health workers in Portugal are concentrated in the coastal areas and greater
Lisbon and Oporto.
Evidence suggests that there are major geographic disparities in the distribution of NHS health
workers by profession and by region, according to the latest available year. Excluding junior
doctors, the Lisbon area concentrates most NHS doctors (250 per 100 000 population), NHS nurses
(496 per 100 000) and pharmacists (145 per 100 000), whereas the North region concentrates most
dentists (94 per 100 000). Alentejo is the region that systematically ranks with the lowest ratio
of NHS doctors (100 per 100 000), NHS nurses (273 per 100 000) and dentists (36 per 100 000).
Algarve has the lowest ratio of pharmacists (72 per 100 000). These findings are not surprising,
since international reports have already identified Portugal as one of the countries – together with
Austria, Belgium, Czech Republic, Greece and Slovakia – where physicians are concentrated in
the capital city (OECD, 2011).
Among NHS doctors, Alentejo also has the lowest ratio of GPs (41 per 100 000), well below the
Lisbon area (69 per 100 000). Additionally, Alentejo and the Algarve have the lowest ratio of
psychiatrists (2 per 100 000), whereas the Lisbon area has 7 psychiatrists per 100 000 population.
The geographic distribution of health workers follows the same trend across the different
professional categories: mostly concentrated on the coast between Lisbon and Oporto, with high
density in the two major cities. Only the most important cities in the interior (e.g. Braga, Coimbra,
Viseu, Leiria and Santarém) are able to attract some doctors, leaving major parts of the territory –
mostly rural areas with ageing populations – underserved (e.g. Alentejo). Due to low population
density, access of populations living in rural areas of Alentejo is even more constrained, because
transportation options to Aletenjo main cities are limited, as well as the socioeconomic status
of those populations. Specialists are often concentrated in the region’s main cities (Évora, Beja
and Portalegre).
This means that those living in the interior and in Alentejo and the Algarve regions have more
difficult access to dental care, and most likely to primary and hospital care. It is also important
to note that mental health is an increasing problem in isolated areas in Portugal, such as Alentejo,
meaning that health workers distribution does not meet the population’s needs.
4.2.3 Professional mobility of health workers
Between 2001 and 2015, the number of foreign health workers in the NHS has
peaked in 2004 (4490) and has steadily decreased since then (ACSS, 2016b).
The number of foreign doctors (mostly from Spain, Brazil, Ukraine and Angola)
working in the Portuguese NHS increased until 2005 and has been decreasing
ever since (ACSS, 2016b). However, in 2015 the number of foreign doctors in the
NHS was still higher than in in 2001 (Table 4.6). Among foreign nurses, there
was an increasing trend until 2003, and a strong decrease until 2015 (Table 4.6).
This was mainly due to changes in the Spanish nursing labour market, which
was the main source of immigrant nurses in Portugal (ACSS, 2016b).