Main Health Issues & Characteristics of Portuguese NHS Amélia Fernandes Valencia, July 2002

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Main Health Issues Main Health Issues & Characteristics of & Characteristics of

Portuguese NHSPortuguese NHS

Amélia FernandesAmélia FernandesValencia, July 2002Valencia, July 2002

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Evolution of the Portuguese Evolution of the Portuguese

NHS (National Health NHS (National Health

Service)Service)Main Portuguese Health Main Portuguese Health

Issues & Health IndicatorsIssues & Health IndicatorsMethodology and Strategic Methodology and Strategic

Approach Approach Health Programs Health Programs

AgendaAgenda

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PORTUGAL10.000.000 h (1999)

90.000 Km2

18 Districts (1982)

5 Administrative Regions (1993 RHAs)

+2 Autonomous Regions

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Evolution of the Portuguese Evolution of the Portuguese NHS, 1971-2002NHS, 1971-2002

Evolution of the PortugueseEvolution of the Portuguese NHS, 1971 – 2002 NHS, 1971 – 2002

Future?

Fonte:Relatório da Primavera dos Sistemas de Saúde (2002)

http://www.ensp.unl.pt/saboga/anestra/Default.shtm


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Health Ministry

RHAs

General and specialised

hospitals

“Health units”“Local health units”

Health centres

Regional services of mental health

Associations of health centres

Regional centres for public health


Source: Diario da Republica 1993

NHS structure based on the NHS organic law

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The financing of NHS by GDP (1990-2002) (Values * 109 PTE)

Source:Annual report form IGIF, 2001 and 2002 NHS and 2002 Rectified budget



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Main Portuguese Health Main Portuguese Health Issues & Health IndicatorsIssues & Health Indicators

Medicines Expenditure (in % total health expenditures)

Fonte: OCDE Health Data 2001

9,0

11,0

13,0

15,0

17,0

19,0

21,0

23,0

25,0

27,0

1985 1990 1991 1992 1993 1994 1995 1996 1997 1998

França Alemanha Grécia IrlandaItália Portugal Espanha Reino Unido



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Total Medicines Expenditure ( % GDP)

0,3%

0,5%

0,7%

0,9%

1,1%

1,3%

1,5%

1,7%

1,9%

2,1%

2,3%

1970 1980 1990 1996

França Alemanha Grécia ItáliaPortugal Espanha Reino Unido Irlanda

Fonte: OCDE Health Data 1998



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70,4%

75,5%

29,9%

29,6%

28,1%

23,5%

37,0% 36,3%

1,5% 1,0%

33,1% 34,1%

0,0%

10,0%

20,0%

30,0%

40,0%

50,0%

60,0%

70,0%

80,0%

Cefalosp. 1ª G. Cefalosp. 2ª G. Cefalosp. 3ª G.

NHS (England) - 1999 NHS (England) - 2001 RSLVT - 1999 RSLVT - 2001

Source: SI - ARSLVT and NHS (England)

Cephalosporins Ambulatory Prescription (% over total)


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11,8%

1,2%

12,5%

1,2%

12,8%

1,3%

0,0%

2,0%

4,0%

6,0%

8,0%

10,0%

12,0%

1999 2000 2001

RSLVT NHS (England)

Source: SI - ARSLVT and NHS (England)

Quinolones Ambulatory Prescription (% over total antimicrobians)


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0,0%

10,0%

20,0%

30,0%

40,0%

50,0%

60,0%

70,0%

80,0%

90,0%

100,0%C

anad

á

Din

amar

ca

Fin

lând

ia

Nor

uega

Rei

no U

nido

Sué

cia

Itál

ia

Esp

anha

Por

tuga

l

Privado

Público

Source: Vinhas, J.

Patients in chronically haemodialysis treatments per provider type

PrivatePublic


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20,0%

30,0%

40,0%

50,0%

60,0%

70,0%

1996 57,4% 36,6% 27,9% 29,9% 37,8% 41,1% 49,3% 56,5% 57,9% 61,0% 50,5%

1997 62,6% 41,1% 33,2% 36,9% 40,0% 45,1% 52,4% 61,8% 65,8% 66,9% 60,4%

1999 71,1% 45,4% 37,1% 39,7% 43,3% 47,0% 55,8% 64,4% 69,1% 70,8% 62,8%

0-4 5-9 10-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85 +

Source: Inquérito Nacional de Saúde, Portugal Continental, 1996, 1997 e 1999

Health Care Consumption% people interviewed that declared having consumption in the last 3 mounths


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1990 Governance Agenda, till 1990: - Salary improvements in Public Sector; - Public / Private split (Lei de Bases da Saúde, 1990); - Productivity Increase, in Public Sector. Dénouement in 1990:

- - The new ministerial staff confirms the salaries improvement, but give up in Public / Private split.

2000

Governance Agenda, till 2000: - Set of legislative framework, in view of NHS reform: beginning of a performance based salary (incompatibility in convention medicine; Experimental Salary Model (RRE); waiting lists recuperation programme (PERL); extra-work hours payment´s condition in Urgency Services. Dénouement in 2000: - The new ministerial staff directed salary improvements to an extra-work hours payment. The NHS reform become paralysed.

Two Main Critical Defeats of Health Governance


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Evolution of the population health status

Population health status and utilisation in Portugal, Spain and the UK

Source: OCDE, 1998


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Men < 65 years

Women < 65 years

Men > 65 + years

Women > 65 + years

Mortality Indicator (/100.000)

per cancer a) 1996 1999 1996 1999 1996 1999 1996 1999 Uterus 3,0 2,6 8,7 9,3 Stomach 13,0 12,0 5,5 5,7 182,8 177,3 94,4 84,6 Breast 16,8 14,7 92,4 90,6 Prostate 3,3 3,0 253,8 256,4 Lung 22,3 20,5 3,2 3,7 220,4 226,9 30,5 35,5 Diabetes Mellitus b) 5,9 5,5 4,5 4,4 169,2 195,5 171,7 181,2 Isqueamic Heart c) 34,3 30,5 8,3 8,2 646,9 622,9 412,4 382,4 Cerebral-Vascular d) 30,3 25,7 16,3 14,3 1.555,7 1.335,4 1343,1 1171,7

Mortality Rates (1996-1999)

Source: Director-Geral e Alto-Comissário da Saúde, Ganhos em saúde em Portugal, ponto da situação, 2002


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duas rodassem álcool no sanguecom álcool no sangueinferior a 0.5entre 0.5 e 0.8 g/l0

5.000

10.000

15.000

20.000

25.000

30.000

35.000

40.000

45.000

50.000

duas rodas pesados ligeiros

sem álcool no sangue

com álcool no sangue


Road accidents – Alcoholism rate per vehicle type

Source: Direcção Geral de Viação, 1999

No alcohol in blood

Alcohol in blood

Motorcycles Trucks Tourism


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Indicator (/100 000)

Men, till 65 years

Women, till 65 years

Men, over 65 years

Women, over 65 years

1996 1999 1996 1999 1996 1999 1996 1999

Mortality Rate per road accidents

31,5 22,5 8,2 5,3 54,7 37,6 18,8 12,7

Mortality Rate per AIDS

20,2 17,0 4,1 3,7 3,6 3,4 1,1 0,5

Source: Director-Geral e Alto-Comissário da Saúde, Ganhos em saúde em Portugal, ponto da situação, 2002

Mortality Rate per road accidents and Mortality Rate per AIDS


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9,59,1

11,2

9,8

7,9

8,9

6,3

8,3

14,1

8

9,38,8

10,5

9

17,8

6,9

4,94,4

4,9 5,2

4,2 4,53,8

4,55,1 4,8

5,55,9

5,1 5,15,5

3,0

0

2

4

6

8

10

12

14

16

18E

UR

15

Ale

ma

nh

a

Áu

stri

a

Bé

lgic

a

Din

am

arc

a

Esp

an

ha

Fin

lân

dia

Fra

nça

Gré

cia

Ho

lan

da

Re

ino

Un

ido

Irla

nd

a

Itá

lia

Lu

xem

bu

rgo

Po

rtu

ga

l

Su

éci

a

19852000EURO 15 - Média (2000)

%0

Source: INE

Infant Mortality Rate in EU Countries, 1985 - 2000


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Health ProgramsHealth Programs

Cardio and Cerebrovascular Diseases

1995 (Barcelona) – 2nd International Conference of the “Healthy Heart”: Catalunha’s Declaration

Objectives: demonstrated that investing in the health of the heart, we can

several complications, inability and live loss;

suffering and incapacity of millions of people;

productivity

1999 (Portugal – DGS) – “Saúde, um compromisso”

Aims: implementation of the “Coronary Green Way” in 15% of the national hospital net

less of 20% recurrent CVA in the first two years and guarantee basic functional capacity.

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0,0

100,0

200,0

300,0

400,0

500,0

600,0

700,0

800,0

900,0

1000,0

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

ARS Norte

ARS Centro

ARS LVTejo

ARS Alentejo

ARS Algarve

Continente

Amputations in diabetics (/100 000 diabetics)

NDP (1974); St. Vincent’s Declaration (Italy, 1989); 300 000 - 500 000 diabetics (3-5%, of which 10-12% are Diabetes Type I)Diabetic foot – hospitalisation; 40-60% amputations for NT causes; 15% Diabetic pop. favourable conditions.; annually: 1300 non traumatic amputations of forelimbs (2001); complications contra lateral limb; 5 years › 50% amputation of CL limb.

Source: OPSS Report 2002 in M. R. Gallego Investigation Project, 2002


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• 600 000 asthmatics in Portugal

• “Handbook for Good Practices”

• “Handbook for help children with asthma”; “Handbook for help adolescents with asthma”; “Handbook for help adults with asthma”

• Interactive CD

• 3100 RNEPS integrated schools working in partnership with 600 Primary Healthcare Centres.

“Asthma schools”

Physical Activity

Physical Education Teacher’sHandbook

National Asthma Control Program

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Obrigado

Thank you

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Main Health Issues & Characteristics of Portuguese NHS Amélia Fernandes Valencia, July 2002

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