Health Systems in Transition

Abstract

his analysis of the Portuguese health system reviews recent developments

in organization and governance, health financing, health care provision,

health reforms and health system performance.

Overall health indicators such as life expectancy at birth and at age 65 years

have shown a notable improvement over the last decades. However, these

improvements have not been followed at the same pace by other important

dimensions of health: child poverty and its consequences, mental health

and quality of life after 65. Health inequalities remain a general problem in

the country. All residents in Portugal have access to health care provided

by the National Health Service (NHS), financed mainly through taxation.

Out-of-pocket payments have been increasing over time, not only co-payments,

but particularly direct payments for private outpatient consultations,

examinations and pharmaceuticals. The level of cost-sharing is highest for

pharmaceutical products. Between one-fifth and one-quarter of the population

has a second (or more) layer of health insurance coverage through health

subsystems (for specific sectors or occupations) and voluntary health insurance

(VHI). VHI coverage varies between schemes, with basic schemes covering a

basic package of services, whereas more expensive schemes cover a broader

set of services, including higher ceilings of health care expenses. Health care

delivery is by both public and private providers. Public provision is predominant

in primary care and hospital care, with a gate-keeping system in place for access

to hospital care. Pharmaceutical products, diagnostic technologies and private

practice by physicians constitute the bulk of private health care provision.

In May 2011, the economic crisis led Portugal to sign a Memorandum of

Understanding with the International Monetary Fund, the European Commission

and the European Central Bank, in exchange for a loan of 78 billion euros. The

agreed Economic and Financial Adjustment Programme included 34 measures

aimed at increasing cost-containment, improving efficiency and increasing