Abstract
The Portuguese health system comprises three critical sectors: The State, which intervenes as a regulator of the entire system, and as a planner, provider, and financer of the National Health Service (NHS); the social sector, with a relevant intervention, mainly in continued care; and the private sector, with an essential role in the provision of some types of care. During the last forty years, the State, social, and private sectors' roles have changed either in its definition or terms of the relationship between them. In general, it is possible to identify, and we shall present them in this opinion article, eight political cycles that reflect the political contexts in Portugal, and, consequently, the ideological framework of each cycle.
Highlights
The Portuguese health system comprises three critical sectors: The State, which intervenes as a regulator of the entire system, and as a planner, provider, and financer of the National Health Service (NHS); the social sector, with a relevant intervention, mainly in continued care; and the private sector, with an essential role in the provision of some types of care
In 1979, the creation of the NHS did not substantially change the role and weight of the private sector, which maintained a strong presence in the Portuguese health system
The private sector’s role was explicitly recognized in the 1990 Health Basic Law, which established a hybrid health care system with public and private providers involved in health care provision and the social sector’s role
Summary
The second political cycle corresponded to a short period, between 1980 and 19831, called “Setback in the socialist principles of the NHS”. The country invested less in health, and the State proportionately decreased health expenditure while private spending increased, which reflected the political commitment to limit the State’s financial responsibility, despite the recent inception of the NHS During this period, public health expenditure decreased by 7.5% while private spending increased by 45%4. After the interval of the Central Block government, that occurred between 1983 and 1985, and during which the Social Party (left-wing) and the Social Democratic Party (right-wing) ruled, the Social Democrat Party came into power and started a series of health policies aiming at reforming the health system[1] In those policies, the private sector would assume a more active role, with higher individual accountability for health funding and the enterprise like the NHS orientation. The reforms of this period were strongly influenced by market ideology, mainly regarding
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