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Primary Care and Economic Crisis


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Primary Care and Economic Crisis by Doctor Joana Neto, II Forum Vasco da Gama Movement

Published in: Health & Medicine
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Primary Care and Economic Crisis

  1. 1. Primary Care and Economic Crisis in PORTUGAL Joana Neto Portugal
  2. 2. Health spending accounted for 9.5% of GDP in Portugal in 2012, very close to the average of 9.3% in OCDE countries. Health spending as a share of GDP is much lower in Portugal than in the United States (which spent 16.9% of its GDP on health in 2012) and in a number of European countries including the Netherlands, France, Switzerland and Germany. Current Situation in Portugal
  3. 3. Current expenditure on health care as % of GDP in Portugal
  4. 4. Changes in expenditure on health care as % of GDP in Portugal, by source of funding
  5. 5. 38% 2% 33% 23% 0% 2% 1% 1% Hospitals Nursing facilities with inpatient and specialist residential care Health care providers in outpatient clinics Retail sale and other suppliers of medical articles Provision and administration of public health programs Administration and health insurance in general Other industries (rest of the economy) Rest of the world Current expenditure on healthcare: total and by type of provider
  6. 6. Gross domestic product (GDP) is defined by OECD as "an aggregate measure of production equal to the sum of the gross values added of all resident institutional units engaged in production (plus any taxes, and minus any subsidies, on products not included in the value of their outputs)." In Portugal, 65% of health spending was funded by public sources in 2012, below the average of 72% in OECD countries.
  7. 7. As in many other European countries, health spending in Portugal fell in recent years, driven largely by government efforts to reduce budgetary deficits following the economic crisis. In 2011 and 2012, the reduction in health spending (including both public and private spending) reached more than 5% per year in real terms.
  8. 8. In many OECD countries including Portugal, the reduction in pharmaceutical expenditure has contributed to the slowdown or reduction in overall health spending in recent years. In Portugal, pharmaceutical spending fell in 2009, 2010 and 2011, with the reduction in 2011 reaching more than 9% in real terms. Portugal has introduced a series of measures to reduce pharmaceutical spending, including price reductions for branded medicines and generics, changes in reimbursement rates for prescribed pharmaceuticals, and a move towards centralised procurement for medicines.
  9. 9. GPs are government employees and have a fixed salary - most GPs work with 35 hours/week contract (but they actually work more, but we do not get paid anything extra...); - small numbers have 42 hours contracts - the new GPs, that have done final exam since 2012, have a 40 hours/week. - (all the trainees have 40 hours/week as well) GP income is dependent on the number of hours contracted to work There is minimal "pay for performance"
  10. 10. Primary Care Secondary Care 40 hour/week for new contracts / 35 to 40h with same salary Increase in the amount payed by the patient for the appointments Doctos can only prescribe medication by the generic name – the pharmacies can choose what to give to the patients Many emergency services in primary care were closed (almost all) – since 2006 Hospitals cannot employ new health professionals (all has to be done through private companies) Changes in the co-payment Inpatient long-term care are being closed Less hospital beds New (but atually worse) informatic programs, that crah all the time New government… + Troika… New rules!
  11. 11. Design Thinking – 1st VdGM Forum