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Reforms in the Portuguese health care sector: Challenges and proposals

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  • Alexandre Morais Nunes
  • Diogo Cunha Ferreira

Abstract

Portugal has one of the most complete public systems worldwide. Since 1979, the Portuguese National Health Service (NHS) was developed based on the integration and complementarity between different levels of care (primary, secondary, continued, and palliative care). However, in 2009, the absence of economic growth and the increased foreign debt led the country to a severe economic slowdown, reducing the public funding and weakening the decentralized model of health care administration. During the austerity period, political attention has focused primarily on reducing health care costs and consolidating the efficiency and sustainability with no structural reform. After the postcrisis period (since 2016), the recovery of the public health system begun. Since then, some proposals have required a reform of the health sector's governance structure based on the promotion of access, quality, and efficiency. This study presents several key issues involved in the current postcrisis reform of the Portuguese NHS response structure to citizens' needs. The article also discusses the implications of this Portuguese experience based on current reforms with impact on the future of citizens' health.

Suggested Citation

  • Alexandre Morais Nunes & Diogo Cunha Ferreira, 2019. "Reforms in the Portuguese health care sector: Challenges and proposals," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(1), pages 21-33, January.
    • Handle: RePEc:bla:ijhplm:v:34:y:2019:i:1:p:e21-e33
    DOI: 10.1002/hpm.2695
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    References listed on IDEAS

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    1. Ferreira, Diogo Cunha & Nunes, Alexandre Morais & Marques, Rui Cunha, 2018. "Doctors, nurses, and the optimal scale size in the Portuguese public hospitals," Health Policy, Elsevier, vol. 122(10), pages 1093-1100.
    2. Barros, Pedro Pita, 2012. "Health policy reform in tough times: The case of Portugal," Health Policy, Elsevier, vol. 106(1), pages 17-22.
    3. Simões, J. & Augusto, G.F. & Fronteira, I., 2017. "Introduction of freedom of choice for hospital outpatient care in Portugal: Implications and results of the 2016 reform," Health Policy, Elsevier, vol. 121(12), pages 1203-1207.
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    Cited by:

    1. Jorge Varanda & Luzia Gonçalves & Isabel Craveiro, 2020. "The Unlikely Saviour: Portugal’s National Health System and the Initial Impact of the COVID-19 Pandemic?," Development, Palgrave Macmillan;Society for International Deveopment, vol. 63(2), pages 291-297, December.
    2. Ricardo, Alexandre Vilar & Costa, Ana Sara & Figueira, José Rui, 2024. "Enhancing hospital benchmarking: A multidimensional approach to quality assessment in Portugal," Socio-Economic Planning Sciences, Elsevier, vol. 93(C).
    3. Guilherme Mendes Vara & Marta Castilho Gomes & Diogo Cunha Ferreira, 2025. "Assessing the performance of Portuguese public hospitals before and during COVID-19 outbreak, with optimistic and pessimistic benchmarking approaches," Health Care Management Science, Springer, vol. 28(1), pages 1-27, March.
    4. Alexandre Morais Nunes & Diogo Cunha Ferreira, 2022. "A Critical Analysis of Decentralizing the Portuguese Public Healthcare Provision Services," IJERPH, MDPI, vol. 19(20), pages 1-10, October.
    5. Rocha, António & Costa, Ana Sara & Figueira, José Rui & Ferreira, Diogo Cunha & Marques, Rui Cunha, 2021. "Quality assessment of the Portuguese public hospitals: A multiple criteria approach," Omega, Elsevier, vol. 105(C).
    6. Miranda, Rafael & Oliveira, Mónica Duarte & Baptista, Filipa Matos & Albuquerque, Isabel, 2023. "Telemonitoring in Portugal: where do we stand and which way forward?," Health Policy, Elsevier, vol. 131(C).
    7. Severin Rakic & Aljosa Djudurovic & Darijana Antonic, 2021. "Financial sustainability strategies of public primary health care centres in the Republic of Srpska, Bosnia and Herzegovina," International Journal of Health Planning and Management, Wiley Blackwell, vol. 36(5), pages 1772-1788, September.
    8. Ana Isabel Plácido & Maria Teresa Herdeiro & João Lindo Simões & Odete Amaral & Adolfo Figueiras & Fátima Roque, 2020. "Voices of Polymedicated Older Patients: A Focus Group Approach," IJERPH, MDPI, vol. 17(18), pages 1-10, September.
    9. Paulo Caldas & Miguel Varela, 2023. "The Portuguese Public Hospitals Performance Evolution before and during the SARS-CoV-2 Pandemic (2017–2022)," Sustainability, MDPI, vol. 15(15), pages 1-31, July.
    10. Arantes, Amílcar & Alhais, Andreia Frias & Ferreira, Luis Miguel D.F., 2022. "Application of a purchasing portfolio model to define medicine purchasing strategies: An empirical study," Socio-Economic Planning Sciences, Elsevier, vol. 84(C).
    11. Alexandre Nunes, 2024. "Vertical Integration in Healthcare and Patient Satisfaction: An Exploratory Analysis of Portuguese Reforms," Sustainability, MDPI, vol. 16(3), pages 1-16, January.

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