Increasing access

How would you evaluate the implementation of the national healthcare scheme in Portugal?

Portugal has made significant progress in both reducing mortality rates and increasing life expectancy at birth in the last 40 years. The introduction of a universal immunization program and the expansion of healthcare services along with improvements in general living conditions have led to reductions in infant mortality rate and a steady increase in life expectancy. Today, Portugal is among the countries with the lowest infant and maternal mortality rates. Over the last 40 years, there was also a shift in the epidemiological features of the Portuguese population, with the increase of non-communicable diseases, namely cancers, circulatory diseases, musculoskeletal disorders, and mental and behavioral disorders. The Portuguese National Health Service (NHS) has contributed to better health status through solid health gains. Nevertheless, as a new era approaches, the challenges to be faced and addressed by the NHS are different and more complex than ever before. For the next 40 years, the NHS has to find innovative and efficient ways to continue to provide healthcare to the population.

How do you assess the synergies between public and private healthcare facilities?

In Portugal, the private sector always played a role in the provision of healthcare services in specific areas. The relationship between the public and private areas is of complementarity though also to some effect competitive; in fact, the Basic Law of 1990 envisaged a competitive relationship between both sectors. Traditionally, the private sector provides care in some of the most lucrative areas and where the public sector fails to provide full or timely coverage, as is the case of medical specialist appointments, elective surgery, and medical exams. In the last two decades, the provision of healthcare services by the private sector has shifted from small medical cabinets, geographically spread, and more abundant in urban areas to variable size, well-equipped, high-quality clinics, and small hospitals where medical specialists are concentrated and specialized, and medical exams are readily available. This happened alongside the increase in the percentage of the population covered by a voluntary health insurance, estimated to be 20% in 2014. There are great examples of the relationship between the private and public sectors in the provision of care, such as the dental voucher, where the government contracts with private providers for specific oral care screenings and treatments for vulnerable groups of the population, or the provision of specific services in community pharmacies that are privately owned and well spread throughout the country. These services are aligned with the national health priorities and programs, namely at the primary healthcare level. Despite the great examples and the existing relationship between the private and the public sectors, there is a need to better define the boundaries between the two sectors, increasing transparency and clarifying funding and stewardship roles.

How do you envision attracting investment into the medical equipment and pharmaceutical sectors?

The Ministry of Health is always focused on attracting innovation into the health system, responding to patients’ needs, and training. We will maintain and encourage the adequate access of medicines and medical devices for citizens and professionals’ safe and rational use of new health technologies, fighting waste, and contributing to the sustainability of the whole system. For example, we have successfully introduced policies for the introduction and stimulation of generic and biosimilar medicines, making them accessible to the population and at the same time improving citizens’ access to therapeutic innovation. NHS also ensures the availability of the latest scientific and technological state-of-the-art medical devices and differentiated products that save lives or significantly improve the quality of life of patients. While improving the access to these innovative products, we have to ensure the health system’s sustainability, improving the definition and uniformity of the products’ characteristics, adjusting the acquisition processes to the effective needs of the institutions, and improving market surveillance and traceability, for example.