The manner in which healthcare in Portugal is organised has been subject to several changes in the past few years. Organic changes have taken place regarding which state entities are responsible for centralising purchases for state hospitals. Public tenders to select suppliers for the Portuguese National Health System (NHS) have been launched through electronic platforms, and there have also been some changes regarding the entity that organises such public tenders. Private healthcare providers have increased their role in providing healthcare services to the population collaborating with the NHS. Furthermore, public expenditure cuts have affected the prices of medicinal products that are reimbursed by the NHS, and drove the government to propose the creation since 2015 of an additional tax applicable to pharmaceutical industry sales. The new Health Law was finally approved in July 2019 and published in the Portuguese Official Gazette on 4 September 2019 (Law No. 95/2019 of 4 September 2019), with two main modifications: the first regarding the recognition of the status the informal caregiver, which is now recognised in law (Law No. 100/2019 of 6 September 2019), and may apply for a subsidy. The second main change of the new Health Law is that the agreements between the NHS and private healthcare providers are envisaged as an exception, and only allowed whenever the NHS lacks capacity to provide the necessary healthcare in time. The extraordinary charge on the pharmaceutical industry (designated as ‘a special charge on the pharmaceutical industry’) was created by the 2015 State Budget, approved by Law No. 82-B/2014 of 31 December 2014, which entered into force on 1 January 2015 and is expected to be maintained in the State Budget for 2020. This aims to ensure the sustainability of the NHS in terms of its expenditure on medicinal products, which applies to entities carrying out the first sale of medicinal products for human use in Portuguese jurisdiction, both where such entities are holders of marketing authorisations or registrations, or are their representatives, intermediaries, wholesale distributors or suppliers holding exceptional use authorisations or other exceptional authorisations for use of medicinal products, remained in force during 2019 and is expected likewise for 2020. The extraordinary charge may range from:
- 2.5 per cent for reimbursed medicinal products included in homogeneous groups or not included in homogeneous groups for which a marketing authorisation has been granted for at least 15 years and with a price less than €10 covering medicinal gases and derivatives from human blood or human plasma, and orphan medicinal products;
- 10.4 per cent for reimbursed medicinal products not covered by the 2.5 per cent rate; and
- 14.3 per cent for medicinal products subject to a restricted medical prescription, as well as those that have an exceptional use authorisation or exceptional authorisation or are intended for hospital consumption.
The sales amount to be considered regarding medicinal products that are reimbursed by the NHS will correspond to the portion of the sale price to the public that is reimbursed by the NHS after deducting value-added tax and another charges on the marketing of medicinal products (called a ‘tax on the sale of commercialised medicines’).
This regime provides a payment exemption of the extraordinary charge by all entities that, individually and unreservedly, adhere to the agreement between the Portuguese state, represented by the Finance and Health Ministries and the Portuguese Pharmaceutical Industry Association (Apifarma), which sets the goals for the maximum amounts of public expenditure with medicinal products and charges according to the sales volume of the pharmaceutical industry companies in order to attain such goals. The entities that adhere to the agreement shall declare it to Infarmed (the Portuguese National Agency for Medicines), and are exempted from the extraordinary charge payment. However, they will be subject to another charge under specific terms of the agreement. The extraordinary charge shall be paid through a declaration with an official template (which was approved by Ministerial Order No. 77-A/2015 of 16 March 2015) and the non-compliance of this obligation results in a compulsory charge collection by the tax authorities.
Organisation of healthcare
The Portuguese Constitution (article 64), consolidated further by the new Health Law (Law No. 95/2019 of 4 September 2019), establish the right of all Portuguese citizens to benefit from public healthcare, which is provided through the NHS healthcare system, that should cover the whole population, be universal for all citizens, be general, ensuring that all types of healthcare are required to promote the health, and free at point of use, taking into account the economic and social conditions of citizens. Citizens of other EU member states may be entitled to public healthcare in accordance with the applicable EU rules. Foreign citizens that are resident in Portugal may also benefit from public healthcare provision in the case of a reciprocal agreement with the foreign national’s home state. The main principles and rules governing public healthcare and the structure of the healthcare system are established in the new Health Law (Law No. 95/2019 of 4 September 2019). Hospitals, healthcare centres for outpatients and other entities included in the NHS comprise the healthcare providers in Portugal.
The NHS depends on, and is financed by, the state and public budget. Private entities and professionals may also render healthcare services to NHS patients pursuant to agreements with the entities representing the Health Ministry. All NHS services and institutions fall under the supervision of the Ministry of Health, which is ultimately responsible for the healthcare sector and defining the government’s national healthcare policy.
Successive governments have continued to organise and reorganise the NHS in past years, mainly since 2002, and specifically regarding the nature and functioning of the hospitals integrated in the NHS and the creation and cessation of public bodies and entities, in particular, in defining and putting into place the relation with private healthcare providers.
In 2019, the rules respecting health-related public-private partnerships (Decree-Law No. 185/2002 of 20 August 2002) were revoked and it is expected that new rules to be approved will narrow the types of structural collaboration of the NHS with private healthcare providers.
Hospitals may have different legal structures. Some remain public hospitals, but most are now public corporate entities, which are regulated by public-law rules but have a certain degree of autonomy with regard to their management. The quality of healthcare services and equipment, generally speaking, is not at stake. The main discussion point regarding the NHS has been the excessive cost to the public budget.
At present, Portugal is divided into five health regions with healthcare centres serving the outpatients of each region, and approximately 225 hospitals, of which 110 are public hospitals, 111 are private hospitals and four are public-private partnerships.
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