Challenges and
opportunities to improve
health in a sustainable way
The challenge for the health system is to consolidate
and further improve the recent gains in health
status, together with improving equity in health, and
to be more responsive to the expectations of the Portuguese
population. However, capacity to respond to
this challenge is threatened in two ways: current patterns
of risky health behaviour, in particular rates of
smoking and the prevalence of obesity, will constrain
improvement in health status; and given the fiscal
capacity of public funding, any attempt to improve
the situation by spending more on the health system
is challenging. Indeed, although the proportion of the
health system financed through public spending was
the lowest of the EU 15 countries in 2007, at the same
time Portugal’s rate of public spending on health care
as a percentage of GDP was at the median of the EU 15
and spending on health care consumed over 15% of
total government spending (3). Additional challenges
include the need to develop coordinated and cohesive
health policies across health sectors, the Ministry
of Health and all government ministries.
However, there are a number of opportunities
for developing policies and strategies in a National
Health Plan (NHP) to meet this challenge. These are
summarized in the following key policy recommendations,
which are further expanded in the full report.
Policy recommendations
1. Develop leadership and invest in capacity
building for incorporating health in all policies and
strengthen mechanisms for interministerial coordination
and intersectoral action focused on health gains.
2. Invest in upstream and gender-responsive
health promotion activities in order to tackle risk factors
and integrate determinants of health into public
health, health promotion and disease prevention programmes.
3. Undertake a comprehensive review of social
determinants of health and of health inequalities and
develop health information systems allowing regular
reporting and monitoring of health equity with respect
to socioeconomic factors, while respecting the privacy
of individuals.
4. Ensure a broad engagement of patients and the
general public in health system decision-making and
pave the way for broader public engagement across
government activities.
5. Further invest in primary health care reforms
and public health as a foundation for attaining health
gains and better management of chronic diseases.
6. Enhance the role of the Regional Health Authorities
in pursuing efficiency and productivity gains at the
local level through better planning according to the
needs of the populations served. Balance efficiency
gains with quality and safety improvements through
optimal planning.
7. Pursue and align policies related to cost containment,
purchasing of health care services and pharmaceuticals.
Further develop support policies to ensure
the sustainability of the health system, such as human
resources for health, innovation and research and
development, and information management policies.
8. Enforce the compliance of public and private
providers with minimum standards and ensure reporting
on a core set of performance indicators, and establish
a platform for health professionals to share best
practices and develop mechanisms to promote continuous
quality improvement of health services.
9. Clarify the role of the private sector through
appropriate regulation: develop and ensure compliance
with requirements for public reporting, standards
of quality and safety, rules for the dual employment
of health professionals, and payment mechanisms
rewarding performance for both the public and private
sectors.
10. Review the most regressive elements of the
financing system in order to improve equity in health
financing.
11. Progressively shift the role of subsystems to one
of complementary coverage, starting by ensuring that
the budget transfers are equivalent to the health care
needs of the populations covered.
12. Develop an integrated strategy for health system
information management in order to report regularly
to the public on health and health care system