Health governance in a context of crisis - the perspective of efficiency and effectiveness in the Portuguese health system

Abstract

<p>The financial and economic crisis from 2008 has<br />a great impact in welfare states, notably in one<br />of their fundamental pillars – health. In Portugal,<br />the total spending on health reached 10.1% of<br />GDP in 2008 and will increase in view of the<br />current panorama. The objective of this study is<br />to analyze the health policies and the Portuguese<br />health system, in a context of economic, financial<br />and social crisis, in the light of the speeches of<br />policy-makers and experts about the processes<br />of governance and contingency measures,<br />considering dimensions of analysis efficiency and<br />effectiveness. In the dimension of effectiveness,<br />measures have been pointed out for protecting<br />the most vulnerable, for the empowerment of<br />citizens, for reduction of inequalities and for the<br />protection and promotion of health. Finally, in<br />the dimension of efficiency, there are important<br />measures to cut off expenditure, of mobilization<br />of financial resources, in the rationalization of<br />resources and services and in professional and<br />organizational development. In theoretical<br />domains of risk and uncertainty, we see through<br />the speeches of policy-makers and experts, that<br />these are domains for the exercise of policies<br />on critical governance processes, determined<br />by identified sources of insecurity, processes of<br />public debate and in terms of policy dispute.</p>