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Chapter 9
The impact of the crisis on the health
system and health in Portugal
Constantino Sakellarides, Luis Castelo-Branco,
Patrícia Barbosa and Helda Azevedo
Introduction
The economic crisis in Portugal is a product of both internal and external
factors. Internally, low investment in tradable goods and slow economic growth
in the first decade of the 21st century led to a lack of competitiveness compared
with the rest of Europe. Weak economic growth was associated with increased
public deficits, as well as increasing private and public foreign debts. Externally,
the global financial crisis resulted in a sudden and sizable increase in financial
market interest rates for the more vulnerable economies in the EU, including
Portugal. Under these circumstances, Portugal was unable to refinance its foreign
debt and was forced to request financial assistance from the EU, the European
Central Bank and the IMF. An Economic and Financial Adjustment Programme
(AP) was agreed between these institutions and the Portuguese Government in
May 2011. The primary challenge for Portugal was to respond to the crisis in a
manner that successfully met the financial targets included in the AP, supported
the development of an economic model centred around tradable goods and
services, and ensured social protection for the Portuguese population.
This case study summarizes policy responses to the crisis in Portugal and reviews
the impact on health and the health system from 2008 to mid-2013. 1 There are
a number of limitations in achieving such an objective:
• the events under analysis occurred at a rapid pace, making it difficult to
identify the effects of specific actions;
• the impact of the crisis is likely to manifest itself in different time frames
depending on particular health and health systems domains; and
• official reports and systematic studies on these matters are scarce.
1 Portugal exited the three-year AP in May 2014.