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Health systems in transition
Portugal
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A relatively large proportion of financing is private, around 35% of total
health expenditure (compared to a European average of around 24%). Over 80%
of this goes on out-of-pocket payments, mainly user charges in private outpatient
care, medicines, dental care and user charges in the NHS (although exemptions
cover much of the population). The rest is mostly spent on premiums to private
insurance schemes and mutual institutions. Private VHI covers about 26% of
the population. Its main role is supplementary (speeding access to elective
hospital treatment and ambulatory consultations, and choice of provider) and,
only rarely, complementary (covering services excluded from the NHS).
Public hospitals are funded through global budgets, but with an increasing
role of activity-based funding using diagnosis-related groups, and private
insurers and health subsystems pay providers. The Ministry of Health allocates
funds to the health regions, based on a combination of historical expenditure
and capitation, which pay for primary care and specific health programmes.
Physical and human resources
In 2014, Portugal had 225 hospitals, 113 of which belonged to the NHS, with
a total capacity of 34 522 beds. Trends in hospital numbers have been similar
to those observed in other European countries; there has been a significant
decrease in the number of public hospitals over the decades, due to the recent
mergers between public sector hospitals and the closing of psychiatric hospitals.
Portugal has a relatively low supply of beds compared with other European
countries, though it is higher than in other countries with similar NHS models,
such as the United Kingdom and Spain.
In 2014, the number of physicians per 100 000 population (442.6) was above
the EU average (349.6). On the other hand, the number of nurses in Portugal
(637.8 per 100 000 population) was below the EU average (864.3), which implies
that Portugal has a low ratio of nurses to physicians. The overall distribution
and density of pharmacies in the country seems to be evenly distributed across
the country, and the number of pharmacists has been growing steadily over the
last 15 years, although it remains low in comparison to similar systems such as
the United Kingdom and Spain.
Portugal faces similar challenges regarding the distribution of health
workers across the population: they are concentrated in the major urban centres
and along the coast, leaving the inland underserved. Adaptations of roles as