OECD Reviews of Health Care Quality: Portugal 2015

Raising Standards

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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.



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.


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