Winter in The Vintage Port City of Porto!: About the Portuguese Healthcare System

Hospital Sao Joao (Public Hospital)

GENERAL STATS TO KNOW ABOUT THE PORTUGUESE HEALTHCARE SYSTEM:

· Healthcare spending = 10% of GDP in 2008 , which is rapidly increasing secondary to a reluctance to impose cost-control measures

o 30% of the total financing for healthcare spending is from private OOP payments and private insurance premiums

· Life expectancy in Portugal – 79.1 years

· WHO Ranked the Portuguese Health Care System #12 of 190 United Nations member nations in overall performance in 2000

· #1 cause of death = cerebrovascular disease (17%) followed by malignant neoplasms

· No major changes have occurred since 1990’s although there has been steady growth of public health expenditure. This is proving to be problematic and is now pushing the government to slowly move away from the government-run system of healthcare and move toward a more privatized system. There are broadly five different areas of intervention, which have been under the spotlight: health promotion, long-term care, primary and ambulatory care, hospital management and inpatient care, and the pharmaceutical market.

Currently the Portuguese health care system is characterized by three coexisting, overlapping systems: the universal NHS; special public and private insurance schemes for certain professions (health subsystems), covering about one-fifth to a quarter of the population; and private VHI providing additional coverage for 10–20% of the population

	The National Health Service (NHS)	Health Subsystems	Voluntary Health Insurance (VHI)
Purpose, funding, access, and other basic information	--Established in 1979 --Provides universal coverage to eligible patients --Managed by the Ministry of health --Funded through general taxation of employers and employees & direct payments by patients and voluntary health insurance premiums -- Short-term European Union visitors through the European Union reciprocal healthcare agreement	--Public and private insurance schemes for certain professions --20-25% of the population utilizes health systems --Financed through employee and employer contributions (including state contributions as an employer) --Pre-dates NHS -- Accounts for 9.24% of health expenditure --Government (through state budget) still contributes close to 90% of the funds since employees typically contribute 1.5% of their gross salary, which is mandatory --Networks of preferred providers that users can choose from --Tax credits available	--Covers between 10-20% of the population --VHI policies are valid for one year and companies have the power to cancel and/or refuse to renew policies --Policies are selective and many try to exclude patients over 65yo --Many plan options exist, much like private insurance in the U.S. --Networks of preferred providers that users can choose from --Tax credits available
Benefits Coverage	Benefits include general and specialist care, hospitalizations, lab services, pharmaceuticals, basic dental care, maternity care, transportation, medical equipment/supplies	Coverage is mostly for outpatient	Covers private practice physicians, pharm products, diagnostic technologies
Costs to the patient	--co-payments have been increasing --level of cost sharing highest for pharm products -- no ceiling on co-payments annually --co-payments generated under NHS hospitals = 0.7% of the total NHS expenditure, PCP covers 0.28% of total NHS expenditure --co-payments exemptions exist for pregnant women, children less than 12yo , pensioners on low income, persons caring for disabled young people, socially and economically disadvantaged -- patients over 65yo are exempt from 50% of inpatient user charges --social security beneficiaries are exempt for these user charges --Highest co-pay = 8.75€ --Average cost per visit to a central/public hospital ED = 143.50€	--Co-insurance (patient pays a fraction of the cost in addition to contribution through wages)	--Co-insurance (patient pays a fraction of the cost in addition to the contribution through premiums)
Biggest Advantage	--Comprehensive coverage of primary care and hospital services	--Access to private facilities and private specialists under this plan --Supplemented with NHS, so patients also have access to the public sector as well	--Wider access to specialists and diagnostic services -- Hospital facilities are updated, with modern architecture, state of the art equipment, and readily available new technologies
Biggest Disadvantage	--Limited outpatient treatment, geriatric assistance, terminal illness services, psychiatric treatment	--Funds are limited and a lack of cost-containment is presenting a challenge in the ability of the government to continue supporting this program	--Increasing costs to the user --Limited accessibility to patients with pre-existing conditions and for patients that are up in age
Changes that are in the works	---Decentralization efforts aimed at shifting financial management and administrative responsibility to the regional levels		--More active role in management of public facilities through PPPs (public-private partnerships)

HOW ARE HOSPITALS PAID?

- All hospitals belong to the NHS in the public sector. Private hospitals that are either non-profit or for-profit have their own management arrangements. Currently, the number of public hospitals is decreasing and as public hospitals are beginning to partner with private hospitals in an effort to move toward a more mixed system.

- Budget allocated by the Ministry of Health and payments from patients for special services (e.g. individual private rooms), from health subsystems or private insurance, and flat-rate user charges for outpatient and diagnostic services

- Fees are based on DRGs and previous year’s charges

HOW ARE DOCTORS PAID?

- NHS docs are salaried

- Private docs are fee-for-service, with fees negotiated individually with health subsystems and VHIs. These fees are paid after services are rendered.

- A lot of doctors do both to augment their income

- Highest physician’s average monthly of 5013€

- Lowest paid physician’s average monthly income is 1769€

- Average income for a physician is 35,000€ annually

- Average income for the general population is 15,400€

Pictures below are from the new public Cancer Hospital across from the Hospital Sao Joao - they have state of the art facilities and access to diagnostic imaging and new surgical technologies. This is considered one of the best cancer hospitals in Portugal.