The Impact of Contracting on the Portuguese National Health System

Abstract

All treatments, materials, instruments, exams, vaccines, tests, hospitalizations, surgeries, human resources, investigations, medicines, autopsies, among many other services provided by the National Health System (SNS). Therefore, funding is required, and the external services and supplies to which the SNS must constantly update its technologies and the necessary and continuous training and essential maintenance and cleaning expenses. Moreover, health financing has been a matter of great concern, both nationally and internationally, as health expenditures are growing faster than economic growth. Over the years, efficiency in resource allocation has always been a desirable objective, but one that is not easy to achieve. The truth is that there is much waste in allocating resources. Thereby, this study analyzes the impact of the contractualization process to which Portugal has adhered, which is most similar to a privatization model; that is, we sought to understand whether the contractualization of the SNS has a favorable effect on the economic level. However, after the entire process and development of the work, it is concluded that the contracting had a negligible impact. The repercussion that it had on the economic performance of Portuguese Hospitals was in a negative sense. In the statistical analyses it was used tests of differences between averages, to check the behavior of the economic performance of hospitals towards the contracting process. It was taken data of reports and accounts from a sample of fifteen Portuguese Hospitals S.A. that went through this contracting process from 2003 to 2017, in order to calculate the four indicators, such as: Return On Assets (ROA); Return On Equity (ROE); Economic Value Added (EVA) and the Market Value Added (MVA). For each of these indicators, were analyzed and compared the resulted effects between the period of two years before and two years after the contracting process. From the obtained results, we can conclude that contracting process had little impact on the economic performance of Portuguese Hospitals and the resulting impact was not favorable.