Portugal is one of the countries in Europe with the largest number of Brazilian immigrants, and it stands out for the quality of life it provides to its inhabitants. Any Portuguese citizen or resident, who pays social security, can receive assistance under the NHS(National Health Service), although patients also need to pay a certain amount of money.
The first Social Security Law (SS) appeared in Portugal in 1946, with the creation of Las Caixaes de Previdência, which provide medical assistance to workers and their dependents, and are financed with contributions from workers and employees. In 1958, the Ministry of Health and Assistance was created, and during the 1960s, legislation was drafted defining the nature and obligations of hospitals and the State's commitment to co-finance the installation and operation of health centers.
The Carnation Revolution, in April 1974, marks the beginning of the modernity of the Portuguese health system, and the right to public health in Portugal would be integrated in 1976 in the Constitution of the Portuguese Republic. However, it was only in 1979 that the National Health Service (NHS) appeared, to guarantee citizens the necessary assistance by creating a universal and free health system.
The financing system is public - through taxes - and after more than 40 years, the development of the Portuguese NHS continues to be subject to political fluctuations and has not yet reached its own identity. Currently, there is a fragmented NHS, where regional inequalities are a problem and service segmentation is the norm.
Primary Care (Primary Health Care)
In 2014, health expenses in Portugal represented 9.5% of GDP, more than in Spain or the United Kingdom. Despite this, 35% of the funding is private through co-payments and direct payments in the laboratory, pharmacy, visits to specialists, general practitioners, and emergencies, while the rest comes from direct and indirect regressive taxes.
The Minister of Health decides the total budget based on a historical financing system (92%) and adjusted funding for demography and diseases (8%). In 2014, per capita, health spending was $ 2,689.9 and the average in the European Union (EU) was $ 3,379. In 2012, Portugal was one of the countries with the greatest inequalities in the EU.
- Services provision
The provision of services in the PC (primary care) is carried out through Health Center Groups, in charge of an executive director who coordinates the different units in which they are divided. These groups are equivalent to the health areas, and they are divided into Family Health Units (FHU), Personalized Health Care Units (PHCU, which correspond to health centers), Community Care Units (CCU), Units Public Health (UPH) and Shared Assistance Resource Units (SARU), the latter bringing together physiotherapists, psychologists, nutritionists, social workers, etc.
Coverage has been universal since 1979 and this is also true for immigrants (since 2001), with or without documents, providing basic assistance in PC (primary care) and specialized care (SC).
Dental treatments, hemodialysis, diagnostic tests, etc., are performed by private providers. Co-payment exists for consultations (€ 4.5 for PC and € 7.00 for SC), access to the emergency department (€ 14.00 in PC and € 18.00 in hospital), home visits and diagnostic and therapeutic procedures, with a ceiling of € 40 / episode, but no annual ceiling as in Sweden.
About 6.1 million people, or 60% of the population, are exempt from payment: under 18, unemployed, pregnant women, bone marrow and blood donors, people below a specific income limit, firefighters, etc. In the pharmacy, co-payment depends on the therapeutic value of the medication.
Retirees are not exempt, although they have a reduced contribution. People with chronic illnesses do not pay for specific medications. Although it is not considered, for obvious reasons, in Portugal there are also informal payments (undeclared payments to health personnel).
General practitioners are the gateway to the system (gatekeeper function), as well as in Spain and the United Kingdom. Consultations with specialists and access to emergencies are strongly regulated, but the mechanism has many flaws. Citizens with private coverage directly access specialized medicine and there is an abuse of demand for emergency hospital services.
Patients have the right to choose the doctor, as long as it is located in their geographical area of residence. Registration with a professional is not mandatory and, in some cases, patients are on a waiting list because there are not enough professionals in the field. You can change doctors whenever you want, upon request to the executive director of central services and explaining the reasons for the change. The right to choose a hospital depends on waiting lists and certain medical conditions.
Doctors are employees who work in teams from Family Health Units or Custom Health Units, in locations relocated to old buildings (usually ineffective and inappropriate). The number of doctors is above the European Union average, however, they are poorly distributed as there is no geographic regulation.
A doctor's salary is the sum of a fixed rate per professional category and years of service, in addition to other specific values attributed to productivity. The number of hours increased from 35 to 40 hours per week due to the crisis, and there are different types of work: full-time wage with exclusivity, without exclusivity, or part-time.
Approximately half of the professionals have private offices and there is no clear line of separation between work for the public or private system. The gross monthly salary of a professional range from € 5,043.40 for a specialist to € 1,931.20 for a resident. Shifts are ways to increase wages and can represent 30% of it.
The functions of doctors in FHU are: care for women (pregnant or not), children, vaccination, management of chronic diseases, monitoring of incapacity for work, screening, etc. In this type of center, professionals obtain an economic incentive for the objectives achieved. They also perform public health functions, due to the deficit of these professionals, such as water quality surveillance, air pollution, labor inspections, buildings, etc.
Continuous care is provided at the medical center by calling 118 from 4:00 pm to 10:00 pm every day, and on Saturdays from 2:00 pm to 10:00 pm across the country. The amounts paid per shift vary between € 25-60 / h.
Other professionals such as nurses, technicians, physiotherapists, radiology service and laboratory, etc., are part of the FHU and PHCU. Nurses have civil servant status and technicians and administrators do not. The latter, unfortunately, are very poorly paid.