Crisis and healthcare in Portugal Álvaro Moreira da Silva Health Regulation Authority, Portugal.
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Transcript of Crisis and healthcare in Portugal Álvaro Moreira da Silva Health Regulation Authority, Portugal.
Crisis and healthcare in Portugal
Álvaro Moreira da Silva
Health Regulation Authority, Portugal
Outline
1. Political and economic background
2. Recent healthcare policy in Portugal
3. Healthcare system performance
4. Conclusions
In the shadow of crisis, a new kind of healthcare emerges…
• “Growing healthcare gaps, as crisis hits poorer parts of Europe”.
• “European healthcare keeps improving, in spite of crisis”
• “Empowered patients contribute to healthcare improvement”.
Health Consumer PowerhouseEuro Health Consumer Index 2013 repo
1. Political and economic background
0
20
40
60
80
100
120
140
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
perc
enta
ge
0
2
4
6
8
10
12
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
perc
enta
ge
Public debt as % of GDP Public deficit as % of GDP
SGP limit
SGP limit
0,0
2,0
4,0
6,0
8,0
10,0
12,0
14,0
16,0
18,0
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
perc
enta
ge
-4
-3
-2
-1
0
1
2
3
4
5
6
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012pe
rcen
tage
cha
nge
Unemployment rateReal GDP growth rates (2006 prices)
1. Political and economic background
• On 16 May 2011, EU and IMF approved a €78 billion ‘bailout’ package
• In exchange, Portugal signed a Memorandum of Understanding (MoU):
– committing itself to strict economic policy conditionality
– aimed at reviving growth and ensuring fiscal and financial stability and sustainability
– including transversal and sector-specific reforms, most implying substantial cuts in short-term public expenditure and rationalisation of public services
Healthcare system in the MoU
Targets:• Improve efficiency and effectiveness• Rational use of services and control of
expenditures• Savings in the area of pharmaceuticals• Savings in hospital operating costs
Content:• Mix of structural reforms and short-term changes
2. Recent healthcare policy in Portugal
2. Recent healthcare policy in Portugal
Healthcare system in the MoU
Scope of measures:• NHS and public subsystems financing• Pharmaceuticals and the pharmacies’
sector• Prescription and monitoring of prescription• Centralised purchasing and procurement• Primary care services• Hospital services• Cross services
3. Healthcare system performance
• A system under pressure:– MoU conditionality– Financial difficulties (overall and health-
specific)– Demographic changes
• Healthcare policy effects:– Changes intended to tackle problems and
assure financial sustainability– But concerns over negative impacts in
quality, access, health status and equity
Healthcare system performance – health status
Life expectancy at birth
Infant mortality rate (age<1)
Total mortality rate
Suicide rate
74
75
76
77
78
79
80
81
82
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
year
s
Portugal EU-15
0
1
2
3
4
5
6
7
8
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
dea
ths
per
1,0
00 li
ve b
irth
s
Portugal EU-15
700
800
900
1000
1100
1200
1300
1400
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
dea
ths
per
100
,000
popul
atio
n Portugal EU-15
0
2
4
6
8
10
12
14
16
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
dea
ths
per
100
,000
popul
atio
n
Portugal EU-15
Healthcare system performance – access
Doctors consultations
Waiting time for surgery
Patients complaints by subject
6,9
4,4
3,73,4
3,1 3,33,0 2,8
2006 2007 2008 2009 2010 2011 2012 2013
med
ian
in m
ont
hs
0
1
2
3
4
5
6
7
8
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
num
ber
per
cap
ita
Portugal EU-15
43,3 44,3 44,2 42,7 39,9 40,9 43,5 46,3
39,8 37,7 33 31,6 31,6 28,5 27,6 26,5
7,1 7,56,8 9,2 9,4 8,7 9,2 9,7
9,8 10,5 16 16,5 19,1 21,9 19,7 17,5
2006 2007 2008 2009 2010 2011 2012 2013
perc
enta
ges
of t
otal
Quality of care Access and wating times Financial issues Other
Healthcare system performance – expenditure
Total expenditure on health Out-of-pocket payments
Public expenditure on health
OOP share:2011: 27%2012: 29%
1012141618202224262830
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
% o
f to
tal e
xpen
ditu
re o
n he
alth
Portugal EU-15
6
7
8
9
10
11
12
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
% g
ross
dom
estic
pro
duc
t Portugal EU-15
60
62
64
66
68
70
72
74
76
78
80
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
% o
f tota
l exp
enditur
e on
heal
th
Portugal EU-15
Healthcare Quality Measured as OutcomesOutcomes scores in EHCI 2013
Health Consumer PowerhouseEuro Health Consumer Index 2013 report
Waiting times in European healthcare 2013
Health Consumer PowerhouseEuro Health Consumer Index 2013 report
Closing the gap between the patient and professionals
Health Consumer PowerhouseEuro Health Consumer Index 2013 report
EHCI 2013 total scores
Health Consumer PowerhouseEuro Health Consumer Index 2013 report
3. Healthcare system performance
Portugal
• Makes a very impressive climb: 16th place on 671 points (up from 25th place in 2012).
• This is all the more remarkable, as Portugal is one of the countries most notably affected by the euro crisis!
Health Consumer PowerhouseEuro Health Consumer Index 2013 report
4. Conclusions
• Impacts of recent healthcare policies are not yet completely observable
• Not easy to disentangle from the effects of the crisis itself
• What do aggregate indicators tell us?– Health status and access to health care
have not been deteriorating since 2009– The financial burden with health care is
increasingly falling on families.
