Funding of telemedicine in the Portuguese National Health Service

Abstract

The funding of the Portuguese National Health Service is based on the state budget, i.e., in public taxes. As a public service, the National Health Service has some constraints in giving financial incentives to discriminate the quality and quantity of services. There is an effort towards this direction, through separation between public payers and public providers, i.e., inside the National Health Service, there is a public entity (named ACSS) which has the responsibility to pay for services to public providers (health centers and hospitals). Complementing this effort, a methodology was launched based on internal contracts, e.g., a public hospital is committed to achieving productivity goals and receives funding from the ACSS, according to the degree of achievement. In a similar way, telemedicine has followed this methodology. Telemedicine in Portugal relates primarily to the following types of services: online and store-and-forward teleconsultation in dermatology, where the hospital dermatologist provides support to the family doctor in the primary health care, and remote monitoring in chronic obstructive pulmonary disease patients, where the hospital provides support to these patients at home. Online teleconsultations are made with videoconferencing equipment and the store-and-forward teleconsultations are related to sending photographs from the primary health centre to the dermatologist doctor in the hospital. A teleconsultation between hospitals and health centres, both in its online or store-and-forward version, is financed with a 10% increase over a standard consultation. In this case, funding is per procedure or medical act and has no upper maximum. Currently, there are 5 public hospitals participating in the telemonitoring program of patients with chronic obstructive pulmonary disease. Each hospital has a maximum of 15 patients at home who are continuously telemonitored, with the technical support of private companies. These hospitals receive a fixed amount per user and per year.