Health insurance is a serious topic in our life. The uncertainty about when and how we will be sick make us want to ensure that we will be able to have some financial help in a possible unhealthy situation. Customers want the access to health care without financial constraints and reduce the payments of possible contingencies. According to that an insurance premium is based on the probability of a person being sick, making it fairer since unhealthy people will pay a higher premium that people with health.
A health insurance can be public or private. In Portugal the public insurance is known as Serviço Nacional de Saúde (SNS). This service allows every single person having the treatment needed in a sick situation without paying the total cost of the procedures; in fact the unhealthy person only has to pay a user charge. A user charge is the amount of money that a SNS user has to pay for the service received, and the main goal of it is reduce the number of people that use the health system without really need it. The big question is: are the user changers having a real impact in the reduction of the number of people in the health system?
In the last two years, the user charges in Portugal increased almost to the double, not only to reduce the number of people that use the health system without need it but also to increase the government’ revenues. The overuse of the SNS has been a serious problem in the Portuguese health system, because it increases the expenditure and decreases the quality of the service. The charges implementation, however, released a new question related to the access of the health system. To prevent the incapability of having the treatment needed, the government implemented user charges exemptions, which is a benefit given to people with low income in order to make them able to consume health as much as they rest of the population. Despite the incentive, poor people still are the unhealthiest. This situation seems contradictory, since they are those who consume more health, but the fact is that the low income make them unable of having an adequate feeding with all the nutrients needed to be a healthy person and not vulnerable.
In conclusion, the increase in the user charges did not have the government’ desired impact, since the number of people using the SNS just slightly decreased. This happened because the highest health consumers are those who are user charge exempt, making for them this measure irrelevant. Although, this measure had the goal of reduce expenditure, the recent economic crisis and the decreased of the financial resources of a significant proportion of the population increased the number of people with full insurance making the government task harder.
The real issue for government has to do in understands the real impact of the user charges and if this is the appropriate mechanism to improve the Portuguese health system.