Table 2 Key areas of MoU’s health care reforms and austerity measures in the National Health Service (NHS), Portugal

Pharmaceuticals

Reduction in public spending

▪ Revision of pricing system, price reduction in expenditure for Pharmaceuticals

▪ Reduction in the regulated price increase rates for pharmacies

▪ Reinforcement in compulsory prescription (INN prescription) of generic medicine

▪ Formation of intensive monitoring mechanisms with evaluation and response to physicians and pharmacies

▪ Introduction of clinical guidelines

▪ Compulsory electronic-prescriptions (e-prescriptions) by active substances for consistent monitoring, evaluation and reporting

Primary care services

Reinforcement of provision and efficiency of the Primary care services

▪ Equal allocation of general practitioners (GPs) throughout the country

▪ Restructuring of Health care units (ACES) into family health units ‘Unidades de Saúde Familiares’ (USFs)

▪ Wages and services associated payments

▪ Introduction of electronic platform of medical records assessed by primary care providers and hospitals

▪ Increase of the number of USFs to achieve an even geographic distribution of GPs

Hospital care services

Centralization and Reorganization of public hospitals: Attainment of savings in operational costs

▪ Merger of several hospital outpatient services to primary care units

▪ Staff reallocation, rationalization of resources and facilities

▪ Management of staff working hours: Decrease in staff overtime compensation

Co-payments

Increase in NHS co-payments – user fees, ‘taxas moderadoras’

▪ Revision of the of the NHS cost-sharing schemes (co-payments) to reinforce Primary care usage [see Table 5]

▪ Automatic Indexation to Inflation of co-payment taxes

General healthcare cost reduction

▪ Fundamental revision and adjustment of accompanying exemption rules for healthcare payment

▪ Reduction in tax allowances for healthcare expenditure by two thirds (incl. Private insurance expenses)

▪ Revision in provision and purchasing procedures to accomplish savings by centralising procurement (i.e. reduction in transaction costs)

▪ Cuts in non-emergency transportation to healthcare facilities