The future of

Portugals welfare system

The Lisbon Summit, February 2014
Structural reforms: core values
Source: Health 2020 - European health policy framework,World Health Organization
Universal coverage 1.
Equity in access 2.
Improved health care quality 3.
Solidarity in health financing
4.
2
Diabetes
Reduce diabetes specific mortality, by reducing in-hospital mortality from all
causes in people with diabetes by 10% until 2016
Clinical area Goals
HIV infection
and AIDS
Reduce the number of new HIV infections by 25% and the number of deaths
from AIDS by 50%, until 2016
Prevention and
control of
tobacco use
Reduce by at least 2% the prevalence of smoking in the population over 15,
until 2016
Promotion of a
healthy diet
Control the incidence and prevalence of overweight and obesity in children,
slowing down its growth until 2016
Mental health
Reduce the impact of mental health, measured as a reduction of up to 5% of
the number of chronic patients institutionalized
Oncology
Increase the coverage of breast and cervical cancer screening, ensuring a
coverage of more than 60% until 2016
Respiratory
diseases
Reduce the rate of inpatient admissions due to chronic respiratory diseases by
10%, until 2016
Cardio- and
cerebro-vascular
diseases
Reduce the mortality from cardiovascular diseases by 1%, until 2016
An ambitious National Health Plan
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Budget evolution, 2000-2013
4
Portuguese research
Sep. 2012: 11 portugueses scientists awarded a
Starting Grant from the European Research Council
(ERC) 1,5 to 2 MEUR
Jan. 2013: Human Brain Project, 2013-2023, funded
by the European Comission (EC) - 1190 MEUR
June 2013: technology to develop cheaper and
more effective biological drugs. Grant from the ERC
(Starting Grant), 1,4 MEUR
July 2013: study of the reasons that justify the
existence of fear; Grant from the ERC, 1,4 MEUR
Recent international grants and awards:
New or revised
legislation:
On clinical
research in
general and
clinical trials in
particular,
Creating a
national platform
for clinical trials.
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Structural reforms
A. Pharmaceuticals policy:
Prescribing by INN
Removal of barriers to entry of generics
Price review
B. Human Resources
Medical work reorganization
Reduction of the amount and price of overtime
Increased mobility
C. Access
Adjustment of user charges and the range of exemptions
Improved access to medicines
D. Increased efficiency and transparency
Improved use of hospital capacity
Review of the outsourcing regimen
Health Data Platform
Electronic prescribing of drugs and diagnostic tests
Pro forma invoice
Combatting fraud
Death certificates Information System (SICO)
E. Primary Health Care
Increase in the number of patients per family doctor
Update of the National Registry of Users
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Ongoing reforms
A. Pharmaceuticals policy:
National drug formularies (for hospital and ambulatory care)

B. Human Resources
Structuring and development of medical careers
Opening of vacancies for senior doctors
Hiring of health care professionals with long term contracts

C. Access
Ensuring family doctors for all citizens
Creation of the role of the family nurse
National System to Notify Incidents and Adverse Events

D. Hospital Reform
Rethinking the supply in obstetrics, psychiatry and long term care
Medical device registry and coding
Definition of the requisites for the reprocessing of single use medical devices
Plan to Rationalize the use of facilites
Centralized purchasing and shared services
Publication and use of clinical guidelines for medical prescription
Pursuing the goal of launching a new Hospital in East Lisbon
Definition of the rules to return hospitals to charities (not for profit organisations)
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Portugal as a destination for medical tourism
Strategic goals:
To grow abroad, to
attract investment and
to conquer new markets

Vectors:
Attract international
partners,
Support international
partnerships,
Use the European
referral network to
attract patients
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Health/
medical
tourism
Quality of human
resources
International
accreditation
Competitive prices
Reputation
Quality
infrastructures
* Does not include the benefit from the reduction in the pharmaceuticals prices
*
Source: Ministrio da Sade
Distribution
of the effort
(2011-2013)
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Pharmaceuticals
Auxiliary exams
Clinical devices
Ambulatory phamacies
Ambulatory wholesale
Health professionals
Overtime
Non-emergency patient-
transport services
Moderating fees *
Other and suppliers
(utilities, consumables, etc.)
Reduce excessive margins
without reducing health care
Managing health care services
in a context of crisis

Reduce
low
added value
health care
Reduce excessive
margins without
reducing health care
Efficiency
Structural reforms
Health promotion and disease prevention
Starting point
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