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Health care reform in Portugal: an evaluation of the NHS experience

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  • Mónica Duarte Oliveira
  • Carlos Gouveia Pinto

    (Instituto Superior de Economia e Gestão, Technical University of Lisbon, Portugal)

Abstract

Since 1979, the Portuguese health care system has been based on a National Health Service structure that is expected to promote equity, efficiency, quality, accountability and the devolution of power. In this article, we analyse the content and impact of policies designed to reform the system between 1979 and 2002. This article differs from previous studies in that it uses a stage-based framework to evaluate the policy-making process and the impact of health care reform throughout different political cycles. We show that the NHS model has never been fully implemented and that many policies have diverted the system from its original objectives. Different governments have endorsed a progressive split between financing and provision and the institution of 'new public management' rules in public providers. We conclude that most policies put forward by Social Democratic governments have aimed at influencing demand, while Socialist governments have targeted the supply side. These policies have led to increases in health expenditure that have been comparatively more cost-shared by the State under Socialist governments. We show some overriding trends, namely as follows: despite huge improvements in health outcomes, the system is nonetheless lasting to meet its goals, particularly in terms of the equity of access and utilisation; accountability problems, inadequacies in the use of operational reforming tools (such as resource allocation mechanisms) and a lack of mechanisms to promote efficient behaviour, are all associated with cost containment problems. Structural reforms have been undertaken since 2002 and these have offered some potential for improving accountability and efficiency. Nonetheless, the success of these reforms calls for certain conditions that do not seem to have been fulfilled. Copyright © 2005 John Wiley & Sons, Ltd.

Suggested Citation

  • Mónica Duarte Oliveira & Carlos Gouveia Pinto, 2005. "Health care reform in Portugal: an evaluation of the NHS experience," Health Economics, John Wiley & Sons, Ltd., vol. 14(S1), pages 203-220.
  • Handle: RePEc:wly:hlthec:v:14:y:2005:i:s1:p:s203-s220 DOI: 10.1002/hec.1037
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    1. van Doorslaer, Eddy & Wagstaff, Adam & van der Burg, Hattem & Christiansen, Terkel & Citoni, Guido & Di Biase, Rita & Gerdtham, Ulf-G. & Gerfin, Mike & Gross, Lorna & Hakinnen, Unto, 1999. "The redistributive effect of health care finance in twelve OECD countries," Journal of Health Economics, Elsevier, vol. 18(3), pages 291-313, June.
    2. Santana, Paula, 2000. "Ageing in Portugal: regional iniquities in health and health care," Social Science & Medicine, Elsevier, vol. 50(7-8), pages 1025-1036, April.
    3. Eddy van Doorslaer & Xander Koolman & Andrew M. Jones, 2004. "Explaining income-related inequalities in doctor utilisation in Europe," Health Economics, John Wiley & Sons, Ltd., vol. 13(7), pages 629-647.
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    Cited by:

    1. de Vries, Jan, 2011. "The shaping of inventory systems in health services: A stakeholder analysis," International Journal of Production Economics, Elsevier, vol. 133(1), pages 60-69, September.
    2. Kwon, Ik-Whan G. & Kim, Sung-Ho & Martin, David G., 2016. "Healthcare supply chain management; strategic areas for quality and financial improvement," Technological Forecasting and Social Change, Elsevier, vol. 113(PB), pages 422-428.
    3. Roberta Longo & Marisa Miraldo & Andrew Street, 2008. "Price regulation of pluralistic markets subject to provider collusion," Working Papers 045cherp, Centre for Health Economics, University of York.
    4. Oliveira, Monica D. & Bevan, Gwyn, 2008. "Modelling hospital costs to produce evidence for policies that promote equity and efficiency," European Journal of Operational Research, Elsevier, vol. 185(3), pages 933-947, March.
    5. Kronenberg, Christoph & Barros, Pedro Pita, 2014. "Catastrophic healthcare expenditure – Drivers and protection: The Portuguese case," Health Policy, Elsevier, vol. 115(1), pages 44-51.
    6. Amado, Carla Alexandra da Encarnação Filipe & Santos, Sérgio Pereira dos, 2009. "Challenges for performance assessment and improvement in primary health care: The case of the Portuguese health centres," Health Policy, Elsevier, vol. 91(1), pages 43-56, June.
    7. Garcia-Prado, Ariadna & Gonzalez, Paula, 2007. "Policy and regulatory responses to dual practice in the health sector," Health Policy, Elsevier, vol. 84(2-3), pages 142-152, December.
    8. Bago d'Uva, Teresa & Jones, Andrew M., 2009. "Health care utilisation in Europe: New evidence from the ECHP," Journal of Health Economics, Elsevier, vol. 28(2), pages 265-279, March.
    9. António Afonso & Sónia Fernandes, 2008. "Assessing Hospital Efficiency: Non-parametric Evidence for Portugal," Working Papers Department of Economics 2008/07, ISEG - Lisbon School of Economics and Management, Department of Economics, Universidade de Lisboa.
    10. Barros, Pedro Pita, 2017. "Competition policy for health care provision in Portugal," Health Policy, Elsevier, vol. 121(2), pages 141-148.

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