OECD Reviews of Health Care Quality

English
ISSN: 
2227-0485 (online)
ISSN: 
2227-0477 (print)
http://dx.doi.org/10.1787/22270485
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These reviews examine the quality of health care in various countries, highlight best practices, and provide a series of targeted assessments and recommendations for further improvements to quality of care in the subject country.

 
OECD Reviews of Health Care Quality: Portugal 2015

OECD Reviews of Health Care Quality: Portugal 2015

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English
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    http://oecd.metastore.ingenta.com/content/8114281e.pdf
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Author(s):
OECD
27 May 2015
Pages:
188
ISBN:
9789264225985 (PDF) ;9789264225978(print)
http://dx.doi.org/10.1787/9789264225985-en

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This report reviews the quality of health care in Portugal, seeks to highlight best practices, and provides a series of targeted assessments and recommendations for further improvements to quality of care. The Portuguese National Health Service has responded well to financial pressure, successfully balancing the twin priorities of financial consolidation and continuous quality improvement. Even in the post-crisis years when GDP fell and health spending declined, improvements in quality of care continued. The need to reduce health spending has been met through a combination of structural reforms, and a well-designed suite of quality initiatives. Reforms around the purchasing and use of pharmaceuticals and medical devices have helped drive down costs, and Portugal has been innovative in how public funds are used to pay providers, increasingly basing payments on quality and efficiency. Important priorities for further work in the Portuguese health system do remain. Portugal will need to improve clinical processes and pathways, particularly in the acute sector. There is still room to improve efficiency, for instance increasing the share of generic drug consumption, and using the Portuguese health workforce more effectively, especially through expanded roles for nurses. Further structural reform is needed with an emphasis on shifting care out of hospitals into less-expensive community settings, and Portugal will also need to reflect on the strategic direction of the primary care system which, following an impressive reform, now risks developing into a two-tiered system with increasingly divergent levels of care quality.

 

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  • Foreword and acknowledgements

    This report is part of a series of publications reviewing the quality of health care across selected OECD countries. As health costs continue to climb, policy makers increasingly face the challenge of ensuring that spending on health delivers value for money. At the same time, concerns about poor quality health care have led to demands for greater transparency and accountability. Despite this, there is still considerable uncertainty over which policies work best in delivering health care that is safe, effective and provides a positive patient experience, as well as which qualityimprovement strategies can help deliver the best care at the least cost. OECD Reviews of Health Care Quality seek to highlight and support the development of better policies to improve quality in health care, to help ensure that the substantial resources devoted to health are being used effectively in supporting people to live healthier lives.

  • Acronyms and abbreviations
  • Executive summary

    This report reviews the quality of health care in Portugal. It begins by providing an overview of policies and practices aimed at supporting quality of care in Portugal (Chapter 1). The report then focuses on three areas that are of particular importance for Portugal’s health system at present: the organisation of primary care (Chapter 2), hospital care (Chapter 3), and optimising quality and efficiency across the system as a whole (Chapter 4). In examining these areas, this report assesses the quality of care currently provided, seeks to highlight good practice, and provides a series of targeted assessments and recommendations for further improvements to quality of care.

  • Assessment and recommendations

    The Portuguese health system has responded well to financial pressures over recent years, successfully balancing the twin priorities of financial consolidation and continuous quality improvement. Even in the postfinancial crisis years (during which GDP fell from USD PPP 23 860 in 2008 to USD PPP 20 188 in 2012, with health spending falling by 6.7%), ambitious quality improvement efforts were sustained. Avoidable hospital admissions for asthma, COPD and diabetes are amongst the lowest in the OECD and Portugal experienced one of the steepest reduction of ischemic heart disease (IHD) mortality rates in the OECD, more than halving from 116.1 deaths per 100 000 population in 1990 to 51.7 in 2011.

  • Quality of care policies in Portugal

    Overall, the Portuguese health system appears to be delivering high quality care at a low cost. Outcomes across primary and hospital care are generally good, and expenditure on health is relatively low, below the OECD average for per capita spending. Portugal has a robust quality architecture, for the most part extending across the health system, which should be commended. In many respects, Portugal is a leader amongst OECD peers. Best practice examples can be found in the Portuguese health system monitoring and information infrastructure, and the use of clinical guidelines for complex patient needs.

  • Primary care provision in Portugal

    The primary care system in Portugal appears to be performing well, based on OECD indicators, with some examples of excellence and innovation backed up by a comprehensive national quality indicator system. The fact that the Portuguese health system is already squarely turned towards measuring, assuring and improving quality will give Portugal a major head start in assuring high quality care going forward. The dynamic and innovative nature of the health system, with a number of impressive initiatives in primary care – for example the introduction of Family Health Units, and a very large cachet of quality indicators for primary care – is another significant strength. Looking to the future, Portugal's main priorities will be, firstly, supporting and expanding areas of excellence and innovation, and, secondly, filling in some key gaps, notably around primary care-led prevention the effective use of the primary care workforce.

  • Improving the quality of hospital care in Portugal

    Portugal has committed significant efforts to reorganising its hospital sector and improving quality of hospital outcome of care in recent years. These efforts – specialisation and concentration of hospital services, new models of hospital management and payment systems, developing quality and safety standards as well as supporting hospital benchmarking – suggest that Portugal is moving toward having a more rationalised hospital system. Portugal has improved hospital outcome of care (such as decreasing both caesarian-section rates and disease-specific mortality rates), and has also reduced hospital spending. Although good progress has been made, space for improvement remains and some areas of weakness can be identified.

  • Quality and efficiency in Portuguese health care

    Following the 2008 global economic crisis, Portugal introduced numerous policy initiatives to cut costs whilst maintain efforts to continuously improve quality. Reforms around the purchasing and use of pharmaceuticals and medical devices have been particularly successful. Portugal has also innovated extensively in how it uses public funds to pay providers, increasingly basing payments on the quality and efficiency of the care provided.

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