Health care quality improved in Portugal, despite tight budgets


26/05/2015 - The Portuguese National Health Service has responded well to financial pressure, successfully balancing the twin priorities of financial consolidation and continuous quality improvement, according to a new OECD report.


The quality of health care continued to improve, even in the post-crisis years when GDP fell and health spending declined – by 1.8% in 2010 and then 6.7% in 2011. Admission rates for conditions that should be dealt with in primary care settings, such as asthma, chronic pulmonary disease and diabetes, are amongst the lowest in the OECD. Portugal also experienced one of the steepest reduction of Ischemic Heart Disease (IHD) mortality rates in the OECD, more than halving from 116.1 deaths per 100 000 population in 1990 to 51.7 in 2011.


The need to reduce health spending has been met through a combination of structural reforms, and a well-designed suite of quality initiatives: per capita spending on health care in Portugal, at EUR PPP 1 967 in 2011, is below the OECD average of EUR PPP 2 507. Reforms around the purchasing and use of pharmaceuticals and medical devices have helped drive down costs. Portugal has also innovated extensively in how it uses public funds to pay providers, increasingly basing payments on the quality and efficiency of the care provided.


However, urgent priorities for further work remain.  Average lengths of stay after a heart attack, at 7.9 days, are higher than countries Portugal should see as peers, such as Denmark where ALOS is 3.9 days, and higher than the OECD average of 6.9 days.  The share of generic drugs consumes, at 30% in 2011, is below the OECD average of 41%, and well below countries like Denmark (72%) and the United Kingdom (75%). Despite some success in reducing variations in the use of certain medical procedures, for instance standardising practices around safe childbirth, significant variation in other areas of medical practice remain; in 2009 there was 39.6% variation in knee replacement rate between regions. To meet the approaching challenge of an aging population and growing burden of chronic disease, further structural reform is needed with an emphasis on shifting care out of hospitals into less-expensive community settings.


The OECD report also recommends that Portugal:


  • Improves clinical processes and pathways, particularly in the acute sector, where health care associated infections appear more common than elsewhere (with a reported prevalence of 10.7% of in-patients in 2011/12, compared to 6.0% EU average), and caesarean-section rate is still the fifth highest rates in the OECD (despite remarkable reduction);
  • Ensures adherence to agreed standards of care and clinical guidelines for hospital and community care;
  • Reflects on the strategic direction of the primary care system which, following an impressive reform, now risks developing into a two-tiered system with increasingly divergent levels of care quality;
  • Focuses on using the Portuguese health workforce more effectively, through expanded roles for nurses and midwifes, especially in primary care. 


Browse the full report at: 


For further information or comment, journalists should contact the OECD Media Division (tel. + 33 1 45 24 97 00).


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