Portugal

Abstract

Abstract In the late 1970s, together with other southern European countries such as Greece and Italy, Portugal took a decided step to change the financing of its health care from a predominantly social insurance base to a tax-financed National Health Service. An argument put forward at the time was that such a change would lead to both greater equity in the burden of payments borne by different income groups and in the provision of treatment to persons with differential economic resources but similar levels of need. In the 1990s, it is clear that political options with regard to health care financing and delivery have changed. As elsewhere in Europe, greater emphasis is now placed on increasing the relative share of direct payments and insurance contributions vis-a-vis tax financing, and on increasing the scope of competition in the provision of services. These developments have been defended strictly on the grounds of efficiency, namely the bureaucratized nature of an NHS-type system, and its lack of cost-saving and quality-promoting incentives to providers and users. Curiously, the questions of how the burden of payments and incidence of benefits are distributed across income groups have virtually been ignored in the recent public debate. In part, this may reflect the paucity of empirical knowledge on the subject. Apart from preliminary work leading up to this chapter, there are no earlier studies in Portugal which measure the attributes examined here, namely vertical equity in financing and horizon¬ tal equity in the delivery of health care. Our results, and their eventual comparison with those from other countries, can, therefore, go some way to redressing the imbalance in the debate.