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Health systems in transition
Portugal
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The health system in Portugal has an extensive information infrastructure
that plays a central role in monitoring system performance. There are electronic
platforms (e.g. an electronic Health Data Platform) storing different kinds of
health information that are used for several purposes. However, not all data
sources are effectively connected and some challenges concerning patient
privacy and the legal basis for connecting patient data remain.
Although there is a strong legal and political commitment to social rights,
the impact of social determinants is not equitable in Portugal and health
inequalities remain one of the key problems for the NHS. These inequities
are determined by geography (people from the interior regions have more
difficulties in accessing health services); income (individuals with low income
face a greater challenge when paying for pharmaceuticals and when accessing
health services not covered by the NHS, such as oral health); and health literacy
(access to the internet and, consequently to a lot of health-related information
available online, is more difficult for the older populations and for those with
a low educational level).
The main source of funding of the Portuguese NHS is general taxation.
However, out-of-pocket payments are an important source of financing for the
Portuguese health system. The process of resource allocation in Portugal is
still moving from historically based allocation of funds towards needs-based
allocation. There is room for further efficiency gains in health care delivery in
Portugal, using health technology assessment to monitor, and so improve, the
system’s quality.
The system has progressively become more transparent, mainly due to the
creation of the NHS Portal, where information of waiting times in emergency
departments and for outpatient consultations at NHS hospitals are available in
real time. At the same time, it is possible to know, in detail, the activity of each
of the NHS units as well as their financial situation and delays in payments to
service providers, though accountability still needs to be improved.
In addressing these challenges, the National Health Council, an independent
body created in 2016 that brings together stakeholders in the health sector, will
have an important role in reaching consensus, acting as a consultant body for
the government and producing studies and recommendations on all issues
related with health policies.