Telemedicine in Portugal
Portugal’s health and care system organisation
The healthcare system in Portugal consists of three coexisting systems: the National Health Service (NHS), special social health insurance schemes and voluntary private health insurance. The Portuguese Ministry of Health is in charge of managing the NHS, which is financed through general taxation. According to the Human Development Report (2010), the average life expectancy in Portugal was 79.1 years. The Portuguese NHS was ranked number 12 in overall performance by the World Health Organization in a 2000 report ranking the health care systems of each of the 190 UN member nations. Portugal’s infant mortality rate has dropped sharply since the 1980s: from 24 of 1000 newborns died in the first year of life to now around 3 deaths per a 1000 newborns.
Primary healthcare covers all population and has been recognize as a case study (WHO, 2008). Primary-care is mainly delivered in NHS health centers, now agregated in Health Centers Groups. In 2009, Portugal had 186 hospitals (86 private) with a total capacity of 35,593 beds (26,077 in public hospitals). Health human resources in Portugal have been characterized by a higher emphasis on specialist hospital care. In 2009, there were 166 specialist for 100 non-specialist physicians (general practitioners). Overall, the number of physicians per 1,000 population is currently above the EU average. The ratio of nurses to physicians is much lower than in most countries.
Portugal’s health and care system financing
The Portuguese healthcare system has three coexisting and overlapping systems: the NHS, a universal, tax-financed system; public and private insurance schemes for certain professions (which are called health subsystems); and private voluntary health insurance. This system has a mix of public and private funding. The NHS, which provides universal coverage, is predominantly funded through general taxation. The health subsystems, which provide healthcare coverage to between 20 and 25 percent of the population, are funded mainly through employee and employer contributions (including contributions from the state as the employer of public servants). Close to 20 percent of the population is covered by private voluntary health insurance.
About 30 percent of total expenditure on healthcare is private, mainly in the form of out-of-pocket payments (both copayments and direct payments by the patient), and to a lesser extent, in the form of premiums to private insurance schemes and mutual institutions.
Financial resources dedicated to healthcare have reached a high level relative to the country’s wealth. Approximately 10 percent of the Portuguese GDP is devoted to health expenditure, which puts Portugal among the countries with the highest level of health spending within the European Union (EU) and the Organization for Economic Cooperation and Development (OECD). Since the mid-1990s, the trend in public health expenditure has been of steady and fast growth, with private expenditure remaining constant, relative to GDP. Recently the European crises have lead to reorganization of services and considerable cuts in costs.
Portugal’s telemedicine strategy and legislation
Portugal launched its national telemedicine startegy in 2000, and has adopted specific legislation that deals with telemedicine. The legislation has clarified liability issues.