• Spending overview
• Policy overview
• Diseases overview

Spending overview

Portugal spent an estimated 10.3% of GDP on healthcare in 2009, which was a higher proportion than in many EU countries, including Spain, Italy and the UK.  Public spending accounts for a little over 70% of total Portuguese healthcare expenditure, a smaller share than in the majority of EU member states. Health indicators have been improving, but remain slightly worse than in comparable western European countries.

The Portuguese NHS is funded mainly via general taxation and provides a comprehensive package of care. Patients make co-payments towards prescription drugs and pay flat-rate fees for medical consultations, emergency hospital visits, overnight hospital stays, home visits and diagnostic tests. In addition to the NHS, insurance schemes exist for certain occupations, to which both employers and employees contribute, and citizens may choose to take out private health insurance. Around 15% of the population has private insurance, mainly through corporate group policies, although individual policies are also available.

The proportion of GDP spent on healthcare and pharmaceuticals will remain high during the forecast period, at just over 10% of GDP, partly as a result of the growing burden associated with caring for the ageing population. This will generate additional pressure to find savings in the budget for the NHS, which is one of the main recipients of public expenditure. The expected poor state of the public finances in Portugal over the forecast period will lead to heavy pressure on the government to restrain growth in public healthcare expenditure.

Policy overview

The NHS is the main provider of general practitioner (GP) and hospital care and employs the majority of the country's doctors. GP care is generally delivered via health centres, each covering around 30,000 people. However, many Portuguese prefer to go directly to hospital emergency departments or to the private sector for care. Private health providers generally supplement the NHS, rather than supplying a complete alternative.  There is little public provision of community care, in a society where families have traditionally provided informal care.

Healthcare standards in Portugal lag behind those in most other countries in Western Europe. The public system suffers from weak management and ineffective spending controls, with the result that spending systematically exceeds annual budgets without the accompanying incremental health benefits to the population. To address these problems, the former PSD-led government (2002-05) began to implement reforms in the health sector, most notably by transferring responsibility for hospital management and budgets from the public to the private sector. Although these hospitals are still formally owned by the state, they are run as public companies, with hospital managers solely in charge of decision-making and cost management, including salaries.

The PS government is continuing the process of converting state-owned hospitals into public companies, giving them new powers of self-government, more transparent financing and more flexible labour frameworks (employees will not be covered by public-sector compensation packages). However, proposed reforms to healthcare provision have met with strong union opposition, and demonstrations forced the resignation in early 2008 of the former health minister, who had failed to sell the reforms to the public.

Diseases overview

Life expectancy in Portugal has risen steadily since the 1970s, but at an estimated 78.2 years (in 2009), it is still one of the lowest in the EU15. The Portuguese have a relatively healthy "Mediterranean" diet, but obesity is nonetheless on the rise, as in other affluent west European countries. The increasing popularity of convenience, ready-to-eat and takeaway meals, which often contain high salt and sugar levels, risks pushing up the incidence of diseases associated with a dietary imbalance. As average life expectancy rises, demand is also expected to increase for treatments for conditions related to old age, such as arthritis, rheumatism and diabetes. This is expected to increase the burden on the healthcare system, which is set to trend upwards in terms of spending as a proportion of GDP in the medium to long term. Communicable diseases, such as swine flu or avian flu, will tend to lead to short-term health scares and public health responses. A more longer-term issue lies with the prevention of HIV infections and the treatment of HIV and AIDS patients.