The recent economic crisis has been leading to monetary restrictions on the budget of public hospitals, which are part of the National Heath System (NHS). It is relevant therefore to ask whether private hospitals, which were in principle less subject to monetary constraints, not being forced to decrease their quality, are a valuable input for the health care of Portuguese citizens.
It is often argued that private hospitals can act as a response for the shortage of financing of public hospitals and therefore be beneficial for the population. Moreover, as acting as competitors, they can put pressure on the improvement of the quality of the NHS. However, an obvious equity problem comes to mind when one reflects on this possible substitutability of public for private hospitals – low-income people not covered by any type of insurance are not able to pay high quality treatments in private hospitals. Another equally serious problem is the increasing transition of high quality public doctors from the public to the private sector. The number of doctors that have left the NHS to work exclusively on the private health system has been increasing in recent years. In fact, today, according to Administração Central do Sistema de Saúde (ACSS), only 30% of public doctors are dedicated exclusively to the NHS. The reason for this shift is firstly the difference on the remuneration systems. It would be, though, quite naïve to assume that doctors solely respond to monetary incentives when it comes to picking the place they want to work. The president of Espírito Santo Saúde, a Portuguese private Healthcare provider, Isabel Vaz, claims that although the monetary reward is the most frequently mentioned factor for the switch from public to private hospitals, it is not the most important. According to her experience, when doctors are considering that switch, they are interested in factors such as who are the professionals who work there, the hospital conditions, the technology and equipment available, the type of surgeries performed or the quality of internal medicine team or the Nurse team.
Public hospitals may therefore end up with less qualified doctors, which might result on two disturbing consequences – on the one hand, the care provided to patients will be of lower quality, and on the other hand, medicine students will be taught by less qualified doctors, since in Portugal the only Medical schools that exist are dependent on public hospitals and their professionals.
To prevent MD to abandon the NHS policy makers should provide both monetary and non-monetary incentives. Definitely, the recent salary cuts for the vast majority of doctors of the NHS (due to the austerity measures) will not be beneficial for the quality of the workforce of the NHS. Adalberto Campos Fernandes, the former president of Hospital Santa Maria, provides some suggestions for the sustainability of the NHS on his proposal “Plano Nacional de Saúde 2011-2016” (2010). Those suggestions include: the transition from contracts that are essentially based on activity towards a model based on health results and performance; the adoption of internal hiring, in order to promote better performance through monetary incentives and quality monitoring; the guarantee of an alignment of professional projects of MD with the mission of the institution and the assurance of the professional valuation of MD.
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Barros, Pedro Pita, Sara Ribeirinho Machado, and Jorge de Almeida Simões. Health System Review: Portugal. Health Systems in Transition, 2011.
Borja-Santos, Romana. “Médicos portugueses estão entre os mais mal pagos da Europa.” Público, 02 17, 2013.
Lusa, por Ana Meireles. “Descer “salário de médicos e enfermeiros não cria valor”.” Diário de Notícias, 06 09, 2012.
Mendes, Diana. “Número de médicos em exclusivo no privado dispara.” Diário de Notícias, 09 20, 2009.
Neves, Miguel Sousa. “Os médicos vão ter de ser os motores da reforma no sistema.” Revista Portuguesa de Gestão&Saúde, 10 2011.
Presidency of the Council of the European Union. “Health in Portugal.” Ministério da Saúde, 2009.
Vaz, Isabel, interview by Timóteo Figueiró. Sistema de saúde tem de ser eficiente(April 2008).
Fernandes, Adalberto Campo et al., “Plano Nacional de Saúde 2011-2016”, Plano Nacional de Saúde,2010.