Health Systems in Transition

Health systems in transition

Portugal

has been adopted elsewhere (e.g. from doctors to nurses) remains a challenge

in Portugal. There are also significant deficiencies in the distribution of health

equipment, which risk affecting the NHS’s ability to meet population needs.

Provision of services

The Directorate-General of Health is responsible for the organization of public

health services at national level.

Portuguese primary care is delivered by a mix of public and private health

service providers. The NHS predominantly provides primary care and acute

general and specialized hospital care. Dental consultations, diagnostic services,

renal dialysis and rehabilitation are more commonly provided in the private

sector (but with public funding to a considerable extent) under contractual

arrangements with the NHS. The creation of Family Health Units, in 2007, and

Primary Healthcare Centre Groups, in 2008, restructured the organization of

Portuguese primary care in order to provide integrated primary care for the

local population.

Secondary and tertiary care is mainly provided in hospitals, which are

grouped into Hospital Centres covering a given geographical area. At the

start of the twenty-first century, one of the government’s objectives was to

increase capacity and value for money in the NHS by increasing private sector

involvement in the building, maintaining and operating of health facilities under

public–private partnerships, drawing on the British model. However, evidence

of their value has been mixed and currently no more public–private partnerships

are planned. Another attempt at vertical integration of health care has been the

establishment of Local Health Units (

Unidades Locais de Saúde

), allowing the

integration of hospitals and primary health care units in the same organization.

However, these have not so far fulfilled the hopes of improved integration.

The National Network for Long-term Care (the RNCCI) created in 2006

combines teams providing long-term care, social support and palliative care,

and brings together hospitals, Primary Healthcare Centre Groups, local and

district social security services, municipalities, as well as private and not-for-

profit institutions providing social services.

The National Institute for Medical Emergencies is the organization within

the Ministry of Health responsible for the coordination and functioning of an

integrated medical emergency system in mainland Portugal, ensuring the rapid

and appropriate delivery of emergency care.