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Health systems in transition
Portugal
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There is a maximum number of pharmacies allowed in each community and
the location of those is highly regulated.
Principal health reforms
Recent reforms in the health sector in Portugal are inevitably linked to the
MoU signed between the Portuguese Government and the three international
institutions in exchange for a €78 billion loan. The reforms implemented
since 2011 by the Ministry of Health are focused on five major dimensions:
regulation and governance; health promotion; pharmaceutical market;
long-term and palliative care; and primary and hospital care; this last area
including a continuation of reforms launched before the Economic and
Financial Adjustment Programme. The overall aim was to cut costs and
increase the system’s efficiency. Overall, most of the adjustment in spending in
the health sector resulted from price effects, a few from quantity cuts, and only
a small proportion resulted from the shift of financial responsibility from the
government to citizens. That was achieved through a reduction in the level of
salaries paid to health workers, cuts in public pharmaceutical expenditure, and
price review regarding private institutions that have contracted with the NHS.
Medical practice was also targeted with the introduction of clinical guidelines.
Future challenges include how to balance financial sustainability with
NHS improvements in underserved fields such as dental care, mental health
and palliative care; and more broadly, how to increase healthy life expectancy.
Moreover, the wage cuts following the MoU have left wages low in comparison
to the private sector and elsewhere in the EU, with a subsequent wave of
emigration by healthcare professionals; ensuring that a sustainable workforce is
a challenge. Improving hospital management is also a challenge, as is continued
improvement of primary care. The goal of including every NHS user in a GP
patient list can only be achieved with serious investments in human resources
and infrastructure, and this is crucial to tackle the current inequalities in
accessing health care.
Assessment of the health system
The period between 2011 and 2015 has been characterized both by the
consolidation of previously launched reforms and the introduction of
new reforms.