Portugal’s Public Health System: Life and Death after COVID-19?

Portugal is home to an ageing population in poor health

What is the state of the Portuguese healthcare system? Full disclosure: this post is not meant to provide a specific answer to such a large question. Rather, we offer a cursory look at some of the issues Portugal’s healthcare system currently faces. All cited sources should be considered for a more comprehensive understanding of this issue.

Things aren’t terrible, but they aren’t great either. In short, the Great Recession of 2008 greatly affected the strength of the system. Austerity measures significantly impaired the ability of the NHS to care for the populace, and public health took a dive.

Some of the negatives include:

Patient out-of-pocket expenses, at 28% of total health expenditures, are substantially higher than the EU average (15%). A shortage of General Practitioners and nurses exists, and it has proven difficult to motivate and retain these workers, especially as a growing number in the public medical workforce have been seeking jobs in the private sector (and abroad). The depth and breadth of services remains limited. In fact, the OECD assessment indicates that “several challenges remain, including the implementation of effective measures to ensure financial sustainability, while improving underserved fields such as dental care, mental health and palliative care”.

The picture is not really that bleak though. There are some positives (by no means is this an exhaustive list):

· Life expectancy is up since 2000 and higher than the EU average

· Mortality rates are down and there’s more awareness of ‘healthy living’ concepts

· Measures increasing transparency and public participation have been implemented

· Portugal ranked 12th in the World Health Organisation’s 2019 rankings

Efforts are underway. The authors of “Reforms in the Portuguese health care sector: Challenges and proposals” (link below) have advocated that, in the medium-term, “it is expected that the Portuguese health care system will have an improved response capacity and a reduction in the demand because of current measures promoting healthy behaviours, reducing avoid- able diseases and enhancing the citizens' quality of life.”

Overall, an awareness of the issues plaguing the healthcare system here has stimulated an effort to improve upon them. Further, from what I’ve seen I my time here, my prediction is that the onslaught of COVID-19 will likely create a dynamic wherein Portugal’s leaders put healthcare front and centre. I fully expect to see a deeper improvement in many of the areas where the system is lacking. It may have been overlooked before, but my inkling is that the political will now currently exists to ensure that the Portuguese healthcare system survives this pandemic very much improved.

Finally, there are still opportunities for the private sector as part of this. One of my personal favourites follows a model pioneered in France, focused on providing improved attention to the needs of seniors (as highlighted in The New Yorker – link below) would be a welcome addition to the needs of those who have continued to experience poorer quality of life as they age.

All in all, the ground underneath us is shifting, but it’s all the more reason to be hopeful that Portugal’s government will take seriously the healthcare needs of its populace, now, and well into the future.

Sources: (Reforms in the Portuguese health care sector: Challenges and proposals)

OECD/European Observatory on Health Systems and Policies (2017), Portugal: Country Health Profile 2017, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.

by @dahungryhubs

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