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Health systems in transition
Portugal
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Organization and governance
The first social security law in Portugal was enacted in 1946: health care was
provided for the employed population and their dependents through social
security and sickness funds, financed by compulsory contributions from both
employees and employers. After the revolution of 1974, a process of health
services restructuring began, which culminated in the establishment, in 1979,
of the National Health Service (NHS), a universal tax-financed system.
Currently, the Portuguese health system is characterized by three co-existing
and overlapping systems: the universal NHS; special health insurance schemes
for particular professions or sectors (e.g. civil servants, employees at banks
and insurance companies), called the health subsystems; and private voluntary
health insurance (VHI).
Planning and regulation take place largely at the central level by the Ministry
of Health and its institutions, whereas the management of the NHS takes place
at the regional level, by the regional health administrations (RHAs) introduced
in 1993. In each of the five RHAs, there is a health administration board
accountable to the Ministry of Health and responsible for strategic management
of population health, supervision of hospitals, management of the NHS primary
care centres, and implementation of national health policy objectives. RHAs
are also responsible for contracting services with hospitals and private sector
providers for NHS patients. Although in theory the RHAs have financial
responsibilities, these are limited to primary care because hospital budgets
are defined and allocated centrally. The Azores and Madeira, as autonomous
regions, have broad powers for their own health care planning and management.
Financing
Total health expenditure represented 9.5% of the country’s GDP in 2014. This is
around 10% lower than its peak in 2010, reflecting the impact of the economic
crisis and the subsequent MoU.
Public expenditure on the NHS accounts for 66% of total health expenditure.
The health subsystems, which collectively provide comprehensive or partial
health care coverage to between one-fifth and one-quarter of the population,
are financed mainly through employee and employer contributions.