Key Recommendations
There are opportunities to respond to these challenges
and improve health system performance. However,
two significant threats to the system may limit
capacity to achieve results: (a) current patterns of risky
health behaviour, in particular rates of smoking and
the prevalence of obesity, will constrain improvement
in health status; and (b), any responses to the challenges
must be fiscally sustainable. Within this context,
the following core policy recommendations can
be formulated.
1. Promote health policies targeting health gains
and reduced health inequalities in all sectors. Ensure
that decisions and investments are planned and undertaken
together with other ministries and agencies to
exert influence on overall government effectiveness.
2. Invest in upstream and gender-responsive
health promotion activities in order to tackle risk factors
and integrate the determinants of health into
public health, health promotion and disease prevention
programmes.
3. Ensure a broader engagement of patients and
the general public in health system decision-making
and take the leadership for broader public engagement
across government activities.
4. Increase value from investments in health by
prioritizing spending on primary health care and public
health, and by enhancing the efficiency of service
delivery.
5. Clarify the role of the private sector through a
coherent policy framework: regulate and ensure compliance
with requirements for public reporting, standards
of quality and safety, rules for dual employment,
and pricing and payment mechanisms.
6. Improve the coherence of public coverage and
subsystem coverage by progressively shifting the role
of subsystems to supplementary coverage.
7. Develop more coherent approaches to the decentralization
of health service delivery: further decentralize
decision-making authority, including budgetary
and financial autonomy, together with corresponding
accountability and performance management.
8. Reduce barriers to the affordability of health
care services: the relatively high level of out-of-pocket
spending on health care services in Portugal requires
policies to reduce their impact, particularly on disadvantaged
households.
9. Develop strategies on human resources for
health that include planning for both appropriate numbers
and mix, addressing professional scope of practice,
and clarifying the role of professional councils.
10. Ensure that health information capacity is sufficient
to promote the use of evidence in developing
policy and in responding to requirements for transparency
and accountability.
A critical element in improving health system
performance with limited resources is the ability to
make policy choices to allocate resources in areas
where they can be most effective in improving health
and equity in health. It is essential to develop the
policy decision-making capacity to address reallocation
of resources based on evidence, recognizing that,
although “health” is the ultimate goal of the health
system, other social systems and policies have a significant
impact on the level of health and on health
inequalities.
Key RecommendationsThere are opportunities to respond to these challengesand improve health system performance. However,two significant threats to the system may limitcapacity to achieve results: (a) current patterns of riskyhealth behaviour, in particular rates of smoking andthe prevalence of obesity, will constrain improvementin health status; and (b), any responses to the challengesmust be fiscally sustainable. Within this context,the following core policy recommendations canbe formulated.1. Promote health policies targeting health gainsand reduced health inequalities in all sectors. Ensurethat decisions and investments are planned and undertakentogether with other ministries and agencies toexert influence on overall government effectiveness.2. Invest in upstream and gender-responsivehealth promotion activities in order to tackle risk factorsand integrate the determinants of health intopublic health, health promotion and disease preventionprogrammes.3. Ensure a broader engagement of patients andthe general public in health system decision-makingand take the leadership for broader public engagementacross government activities.4. Increase value from investments in health byprioritizing spending on primary health care and publichealth, and by enhancing the efficiency of servicedelivery.5. Clarify the role of the private sector through acoherent policy framework: regulate and ensure compliancewith requirements for public reporting, standardsof quality and safety, rules for dual employment,and pricing and payment mechanisms.6. Improve the coherence of public coverage andsubsystem coverage by progressively shifting the roleof subsystems to supplementary coverage.7. Develop more coherent approaches to the decentralizationof health service delivery: further decentralizedecision-making authority, including budgetaryand financial autonomy, together with correspondingaccountability and performance management.8. Reduce barriers to the affordability of healthcare services: the relatively high level of out-of-pocketspending on health care services in Portugal requirespolicies to reduce their impact, particularly on disadvantagedhouseholds.9. Develop strategies on human resources forhealth that include planning for both appropriate numbersand mix, addressing professional scope of practice,and clarifying the role of professional councils.10. Ensure that health information capacity is sufficientto promote the use of evidence in developingpolicy and in responding to requirements for transparencyand accountability.A critical element in improving health systemperformance with limited resources is the ability tomake policy choices to allocate resources in areaswhere they can be most effective in improving healthand equity in health. It is essential to develop thepolicy decision-making capacity to address reallocationof resources based on evidence, recognizing that,although “health” is the ultimate goal of the healthsystem, other social systems and policies have a significantimpact on the level of health and on healthinequalities.
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