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 Powerhouse
Euro Health Consumer Index 2013 repo
2011
2012
2010
12,0
10,0
8,0
6,0
4,0
percentage change
-1
2,0
-2
0,0
-3
-4
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
4
2001
Unemployment rate
5
2000
18,0
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
0
1999
0
1998
2
1998
20
1997
10
1997
100
1996
Public debt as % of GDP
1996
SGP limit
1995
80
percentage
140
1995
2012
2010
2011
40
2009
2007
2008
2006
2005
2003
2004
2002
2001
1999
2000
1998
60
2008
2009
2006
2007
2005
2003
2004
2002
14,0
2000
2001
16,0
1998
1999
1996
1997
1995
percentage
120
1997
1995
1996
percentage
1. Political and economic background
12
Public deficit as % of GDP
8
6
4
SGP limit
6
Real GDP growth rates (2006 prices)
3
2
1
0
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
2. Recent healthcare policy in Portugal
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
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
1300
800
700
Portugal
EU-15
1200
1100
1000
900
Total mortality rate
1
1400
16
14
2
Portugal
Portugal
2011
2012
74
Life expectancy at birth
2008
2009
2010
75
2006
2007
77
2004
2005
78
2002
2003
79
7
1999
2000
2001
8
1997
1998
80
1995
1996
76
EU-15
deaths per 1,000 live births
82
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Portugal
deaths per 100,000 population
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
years
81
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
deaths per 100,000 population
Healthcare system performance – health status
Infant mortality rate (age<1)
6
5
4
3
2
EU-15
0
Suicide rate
12
10
8
6
4
EU-15
0
Healthcare system performance – access
8
Portugal
EU-15
median in months
6
5
4
3
2
4,4
3,7
3,4
3,1
3,3
2010
2011
3,0
2,8
2012
2013
Doctors consultations
1
2011
2012
2010
2008
2009
2006
2007
2005
2003
2004
2002
2006
2007
2008
2009
Patients complaints by subject
Quality of care
9,8
7,1
percentages of total
2000
2001
1998
1999
1997
0
1995
1996
number per capita
Waiting time for surgery
6,9
7
39,8
10,5
7,5
37,7
Access and wating times
Financial issues
Other
16
16,5
19,1
21,9
19,7
17,5
6,8
9,2
9,4
8,7
9,2
9,7
31,6
28,5
27,6
26,5
33
31,6
43,3
44,3
44,2
42,7
39,9
40,9
43,5
46,3
2006
2007
2008
2009
2010
2011
2012
2013
2012
30
28
26
24
22
20
18
16
14
12
10
2011
2010
Portugal
2009
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Total expenditure on health
2008
8
2007
12
2006
9
% of total expenditure on health
10
2005
EU-15
2004
2003
2002
80
2001
2000
1999
62
1998
64
1997
2004
2005
2006
2007
2008
2009
2010
2011
2012
Portugal
1996
6
1995
7
% of total expenditure on health
11
1995
1996
1997
1998
1999
2000
2001
2002
2003
% gross domestic product
Healthcare system performance – expenditure
Portugal
EU-15
78
76
74
72
70
68
66
Public expenditure on health
60
EU-15
Out-of-pocket payments
OOP share:
2011: 27%
2012: 29%
Healthcare Quality Measured as Outcomes
Outcomes scores in EHCI 2013
Health Consumer Powerhouse
Euro Health Consumer Index 2013 report
Waiting times in European healthcare 2013
Health Consumer Powerhouse
Euro Health Consumer Index 2013 report
Closing the gap between the patient and
professionals
Health Consumer Powerhouse
Euro Health Consumer Index 2013 report
EHCI 2013 total scores
Health Consumer Powerhouse
Euro 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 Powerhouse
Euro 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.