The health care reform in Portugal: Outcomes from both the New Public Management and the economic crisis

Abstract

The Portuguese health system concentrates most of its activity in a National Health Service, created in 1979 to promote universal and general access. The National Health Service should ensure equity, efficiency, and quality of all health care delivered services. This study assesses the impact of health care policies between 2002 and 2017, focusing on 3 timeframes: the adoption and adaptation of New Public Management principles to the health care sector (2002 to 2010), the economic and financial crisis period (2011-2015), and the postcrisis recovery period (2016-2017). The current study evaluates the main policy measures in the health sector, presenting their impacts in terms of access, efficiency, accountability, and costs over those 3 economic periods. It was verified that not all the measures implemented by the successive governments obtained the desired outcomes, generating even costs increase, apart from the austerity period in which health expenditure showed a significant reduction because of the financial constraints.

Financial Crisis in Portugal: Effects in the Health Care Sector

“…16 A detailed identification and description of such policies (attempts) can be found in Nunes and Ferreira. 48 Despite those measures and according to these authors, cost containment was not effective because the deficit in the public health sector tended to increase, and the objective of reducing expenses per medical act (or per patient) was not achieved. Tables 1 and 2 show the growth of the Portuguese public and private expenditures in health care, as well as the financing and deficit of the NHS, for the period FY2002-FY2016.…”

The impact of primary health care reform on hospital emergency department overcrowding: Evidence from the Portuguese reform

“…The creation of FHU aimed to improve PHC accessibility, efficiency, quality, and continuity of care and increase the satisfaction of professionals and citizens . One of the consequences of these improvements was supposed to be a reduction in the use of hospital services and a reduction in inappropriate utilization of secondary and emergency services …”

Deconstructing NPM: Public Service Values in a Global Public Administration

“…One example is the outsourcing of the prison and juvenile justice systems in the USA which, while very profitable for the owners and their private-sector suppliers, is bad business for US citizens with increased incarceration rates motivated by a desire for profit; outsourced inmate healthcare cost increases of 385% in the most recent period; and higher death rates for inmates of privatized prisons, to name but a few (Neate 2016). Another is the dramatic rise in healthcare costs, national debt, inequities in healthcare access, and reduced infrastructure investment, all of which contributed to a severe decline in citizens' quality of life following the implementation of NPM practices in Portugal (Nunes and Ferreira 2018).…”