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Introduction of freedom of choice for hospital outpatient care in Portugal: Implications and results of the 2016 reform

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  • Simões, J.
  • Augusto, G.F.
  • Fronteira, I.

Abstract

In Portugal, the National Health Service (NHS) assures universal access to medical treatment and care that is free at the point of delivery – except for relatively small user charges. Freedom of choice is limited and competition between the public and the private sectors is almost non-existent. In May 2016, the Ministry of Health introduced a new law that facilitates the referral of NHS users from primary healthcare units to outpatient consultations in NHS hospitals outside of the referral area. However, for inpatient care, patients are still bound to receive treatment within their referral area, which is determined by place of residence. The aim of the reform was to provide a timelier response to citizens' health needs and to increase efficiency. According to preliminary data from June 2016 to May 2017, 10.6% of all outpatient referrals from NHS primary health care units were made to an NHS hospital out of the referral area, with the highest proportion in the Lisbon (15.8%) region. In general, median waiting time for first outpatient consultation increased after the introduction of choice in the five specialties with the highest proportions of out-of-area referrals - but it reduced in two departments with the longest waiting times prior to the reform. The reform constitutes a major change to the relationship between NHS hospitals, with foreseeable consequences in hospital funding and the patients' perception of hospital quality.

Suggested Citation

  • 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.
  • Handle: RePEc:eee:hepoli:v:121:y:2017:i:12:p:1203-1207
    DOI: 10.1016/j.healthpol.2017.09.010
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    References listed on IDEAS

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    1. Barros, Pedro Pita, 2017. "Competition policy for health care provision in Portugal," Health Policy, Elsevier, vol. 121(2), pages 141-148.
    2. Siciliani, Luigi & Chalkley, Martin & Gravelle, Hugh, 2017. "Policies towards hospital and GP competition in five European countries," Health Policy, Elsevier, vol. 121(2), pages 103-110.
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    Cited by:

    1. Sá, Luís & Siciliani, Luigi & Straume, Odd Rune, 2019. "Dynamic hospital competition under rationing by waiting times," Journal of Health Economics, Elsevier, vol. 66(C), pages 260-282.
    2. Rita Matos & Diogo Ferreira & Maria Isabel Pedro, 2021. "Economic Analysis of Portuguese Public Hospitals Through the Construction of Quality, Efficiency, Access, and Financial Related Composite Indicators," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 157(1), pages 361-392, August.
    3. Fernández-Pérez, Ángel & Jiménez-Rubio, Dolores & Robone, Silvana, 2022. "Freedom of choice and health services’ performance: Evidence from a national health system," Health Policy, Elsevier, vol. 126(12), pages 1283-1290.
    4. 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.

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