Primary Care and Economic Crisis

in

PORTUGAL

Joana Neto

Portugal

Health spending accounted for 9.5% of GDP in Portugal in 2012, very

close to the average of 9.3% in OCDE countries. Health spending as a

share of GDP is much lower in Portugal than in the United States (which

spent 16.9% of its GDP on health in 2012) and in a number of European

countries including the Netherlands, France, Switzerland and Germany.

Current Situation in Portugal

Current expenditure on health care as % of GDP in Portugal

Changes in expenditure on health care as % of GDP in Portugal, by source of funding

38%

2%33%

23%

0%

2%

1% 1%

Hospitals

Nursing facilities with inpatient and specialistresidential care

Health care providers in outpatient clinics

Retail sale and other suppliers of medicalarticles

Provision and administration of public healthprograms

Administration and health insurance in general

Other industries (rest of the economy)

Rest of the world

Current expenditure on healthcare: total and by type of provider

Gross domestic product (GDP) is defined by OECD as "an aggregate measure of production equal to the sum of the gross values added of all resident institutional units engaged in production (plus any taxes, and minus any subsidies, on products not included in the value of their outputs)."

In Portugal, 65% of health

spending was funded

by public sources in

2012, below the average of

72% in OECD

countries.

As in many other European countries, health spending in Portugal fell in recent years, driven largely by government efforts to reduce budgetary deficits following the economic crisis. In 2011 and 2012, the reduction in health spending

(including both public and private spending) reached more than 5% per year in real terms.

In many OECD countries including Portugal, the reduction in pharmaceutical expenditure has contributed to the slowdown or reduction in overall health spending in recent years. In Portugal, pharmaceutical spending fell in 2009, 2010 and 2011, with the reduction in 2011 reaching more than 9% in real terms. Portugal has introduced a series of

measures to reduce pharmaceutical spending, including price reductions for branded medicines and generics, changes in reimbursement rates for prescribed pharmaceuticals, and a move towards centralised procurement for medicines.

GPs are government employees and have a fixed salary

- most GPs work with 35 hours/week contract (but they actually work more, but we do not get paid anything extra...);- small numbers have 42 hours contracts- the new GPs, that have done final exam since 2012, have a 40 hours/week.- (all the trainees have 40 hours/week as well)

GP income is dependent on the number of hours contracted to work

There is minimal "pay for performance"

Primary Care Secondary Care

40 hour/week for new contracts / 35 to 40h with same salary

Increase in the amount payed by the patient for the appointments

Doctos can only prescribe medication by the generic name – the pharmacies can choose what to give to the patients

Many emergency services in primarycare were closed (almost all) – since2006

Hospitals cannot employ new healthprofessionals (all has to be done throughprivate companies)

Changes in the co-payment Inpatient long-term care are beingclosed

Less hospital beds

New (but atually worse) informatic programs, that crah all the time

New government… + Troika… New rules!

Design Thinking – 1st VdGM Forum