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Cuts in Portugal's NHS could compromise care

2012; Elsevier BV; Volume: 379; Issue: 9814 Linguagem: Inglês

10.1016/s0140-6736(12)60174-3

1474-547X

Gonçalo Figueiredo Augusto,

Healthcare Policy and Management

Portugal's debt crisis is forcing hospital closures and hasty reform of the National Health Service, causing some observers to raise concerns about patient care. Gonçalo Figueiredo Augusto reports. The public debt crisis has put Portugal in a precarious situation. The country, like Greece and Ireland, has had to seek financial assistance from the European Financial Stabilisation Mechanism. The bailout requires Portugal to cut down spending in all sectors including the often sensitive health sector. Created in 1979, the Portuguese National Health Service (NHS) is considered a major achievement of the democratic regime. However, three decades later the situation is worrying: public hospitals' debt to medical suppliers has reached an estimated €3 billion, which is jeopardising the sustainability of the NHS. The new Minister of Health, Paulo Macedo, has acknowledged the need for new strategies and approaches in the NHS. “We cannot allow uncontrolled spending to continue”, he said in parliament. As a result, the 2012 budget is the toughest in decades: already subjected to a pay freeze, all pensioners and public servants will see their yearly income decrease substantially with the loss of bonus payments. This move will help to cut health spending by €710 million in 2012. However, the budgeted €7952 million will not be enough to cover spending and the health sector will still close the year with an estimated deficit of €200 million. “This is the budget no minister would like to have”, said Macedo. Notwithstanding, he emphasises that he is against cost cutting “at the expense of lowering the quality of the services”. However, there is some cause for concern. In November, 2011, a government report about a new hospital reform proposed substantial cuts through the myriad of services and hospitals. Controversy arose when the same report suggested that more than 2300 of 19 000 doctors who work in the NHS should be moved from big cities to where they are most needed. The President of the Portuguese Medical Association, José Manuel Silva, recognises that the system is “badly organised” and there is room to improve the health-care coverage in these areas outside cities. But he also acknowledges “there is a huge difference between a theoretical report and its practical application”. Then, in December, 2011, the Minister of Health announced cuts in overtime payments to doctors and the increase of all user fees starting in January, 2012. For instance, fees charged for appointments in primary care rose from €2·25 to €5·00, while emergency visits in primary health-care centres rose from €3·80 to €10·00. The former Minister of Health, Ana Jorge, accused the government of “closing the NHS to the population” in a country where many people do not have a family doctor and rely on emergency services. “The government is penalising those patients by charging an extremely high fee, especially in a moment of crisis such as this one”, said Jorge. Her sentiments are borne out by a report by Portugal's Health System Central Administration records which reveals that around 15% of the Portuguese population are not registered with a family doctor. The latest report by the European Observatory on Health Systems and Policies (EOHSP) also concluded that patients rely too much on emergency services. Even with the increased fees, the inappropriate use of emergency services is still a reality: it is estimated that around 25% of the attendees at hospital emergency units do not need immediate care. Although many problems in the health service need to be ironed out, the government's strategy to close health-care facilities has been getting strong public disapproval. Additional measures are expected to be implemented in 2012, including the introduction of cheaper generic drugs and some more unpopular measures such as the decrease of the public co-payment of drugs. This year will be crucial for Portugal as the bailout and subsequent austerity measures will demand huge sacrifices for its people. The NHS needs to be reorganised and reformed to become sustainable but looking at the 2012 budget it is still unclear how so many cuts will be made without affecting the quality of health-care services. As Pedro Pita Barros, professor of economics and first author of the EOHSP report, wrote on his blog: “There is a need and an opportunity to act for the sake of the NHS.” GFA is a health writer and Senior House Officer in the Portuguese NHS GFA is a health writer and Senior House Officer in the Portuguese NHS