Health Analysis

Although over the past 10 years Portugal has made an improvement in their health indicators, as a result of the implementation of measures and reforms with the aim of improving the efficiency and effectiveness of the healthcare system, the analysis by Deloitte identifies the critical dimensions that threaten the future of the sector, notably the financial unsustainability of the system, inadequate organisational and management models, the inadequacy of the planning and management of human resources, lack of clarity on the role of private entities, the lack of quality information , the weaknesses of the funding model and the lack of strategic planning.

The study "Health Analysis - A vision for the future" Deloitte identifies six major challenges that point out the ways to solve many of the problems identified and also points out the development of a sustainable health system to be more organised with better management.

This field is critical to improve the organisation and governance of the health system and to encourage competition. In this sense, we highlight the importance of separating the role of the provider and the payer and the need to create entities that only focus on activities hitherto dispersed in different structures. For example, the unification of the responsibility for the activities of planning, funding, contracting and payment, the establishment of a holding company of providers of health care and the creation of an agency evaluation of technologies and their inclusion in the SNS.

The level of competition and with the primary purpose of creating incentives for the continuous improvement of the performance of providers, it is important to deepen the freedom of choice within the SNS itself and to prepare the way for the progressive choice between the private and public sector. These challenges imply the availability of reliable information on the clinical performance of providers, creating mechanisms to shut down non-competitive services and the role of the physician as the advisor of citizens.

Also in this chapter, it is essential to deepen the concession of managing health care providers to private and / or public sector groups, which would generate competition among different models, encouraging continual improvement in performances. As a result of this measure, the objective would be to promote the strengthening of economic groups in the health sector, which could export ´know-how´ and internationalize their activities.

The sustainability of the health system will also require a new organisation of care with significant implications for the development of primary health care, the restructuring of hospitals and promoting the integration of care level.

The main challenges are the need to bring medical care to citizens, through the transfer of care currently provided in hospitals for care services, freeing the doctors from tasks to be performed by nurses, and the development of a model clinical outreach focused on the diagnosis and treatment of simple diseases as a way to reduce the inflow of hospital emergencies. In short, you must put the citizen at the centre of the system and promote effective coordination of care between the different levels, where the the family physician plays the role of intermediary between the people and the system.

This reality involves developing a set of processes and information systems and gradually introducing people to this change. The study identifies key measures as the need for better strategic planning, acting at the level of the match between supply and demand, the development of mechanisms for monitoring and for the evaluation of information systems, a human resources policy has been adjusted to the real needs and for the creation of a team to accompany the transformation of the sector.

The cost control and rationalisation of the use must be done not only by the price side but also by the inputs. In this context, we highlight the need to control the use of drugs acting on the prescription and continuing the development of therapeutic guidelines, to promote the risk and the evaluation of the actual consequences of the drugs and drug use, especially in diseases that cause too many problems in society, therefore it is crucial to improve adherence by providing citizens with this information.

You must use the funding as an incentive instrument for the desired behaviours of the service providers, defining different funding models for different services. For example, through using capitation models that emphasise quality and results in more undifferentiated care, and pay to act more specialised care, bringing prices to benchmark costs and promoting efficiency of providers. Likewise, it is important to involve society in the financing decisions of the system, for example, the level of review of the comprehensiveness of the coverage.

These two dimensions must be the basis of the strategic planning in the health sector. For this is critical in the formation of healthy citizens, aiming to reduce the requirement for disease treatment investments; in health education and in the empowerment of citizens, increasing the levels of literacy within the population in matters related to healthy lifestyles and self-care, also, still focusing on the development and implementation of cross-sectorial initiatives involving citizens.

For a full analysis of the health sector and to identify the key issues, challenges, and personalities from various groups of stakeholders in health were interviewed in Portugal. These stakeholders are representative of the various entities involved in the health and medicine sector, particularly in the development and the enforcement of health policies, financing, health care delivery, regulation and production and distribution of pharmaceuticals elements.

Last updated: Wednesday, 9 October 2013