Web-economic-crisis-health-systems-and-health-web

Chapter 9 | The impact of the crisis on the health system and health in Portugal
287
2. Health system pressures prior to the crisis
In recent decades, the health of the Portuguese population has improved
considerably; for example, there has been remarkable progress in infant mortality
over the past 30 years, from the very worst rate in the EU15 in 1985 to one of the
best by 2010 (Fig. 9.1). However there remain many areas where the population
is vulnerable. These include child poverty (Bastos, 2012), unhealthy behaviours
(e.g. motorcar accidents, substance abuse) and a relatively unhealthy ageing
population (OECD, 2012a).
Fig. 9.1 Trends in infant mortality: (a) in Portugal (1960–2012) and (b) in European
countries (2012)
(a)
Mortality (per 1,000 live births)
77.5
55.5
24.3
10.9
5.5 3.3 2.5 3.4
1960 1970 1980 1990 2000 2008 2010 2012
(b)
EU27
Ireland
Greece
Spain
Portugal
Finland
2.4
Mortality (per 1,000 live births)
3.8
3.5
2.9
3.1
3.4
Sources: OECD, 2012b; PORDATA, 2013.
In the decade prior to the crisis, important changes were made to the Portuguese
health system. Following conceptual and organizational developments
introduced in the late 1990s, a comprehensive primary health care reform was
initiated in 2005 by providing support for the rapid expansion of family health
units, known as unidades de saúde familiares, which are small, multiprofessional
public primary health care teams operating under performance contracting that
choose their own leadership, thus setting up a primary health care network.
Other changes included adopting national health strategies and plans (in 1998
and 2004), taking steps towards decentralizing public hospital management
and adopting public–private partnerships for new public hospitals, developing
a long-term care network, investing in new mechanisms for health services