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Chapter 9 | The impact of the crisis on the health system and health in Portugal
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allocation to the NHS decreased by 13.5% between 2010 and 2012, but if the
additional expenses are included, the NHS budget decreased by 14.4%. Using
this calculation of the NHS budget, the budget allocation to finance the NHS
in 2012 and 2013 was, in nominal terms, below the 2006 level and even below
the final allocation of 2005. As a share of GDP, the NHS budget decreased each
year from 2009 until 2012.
Changing rules for financing public insurance of public servants
The Directorate-General of Social Protection for Workers in Public
Administration (Direção-Geral de Protecção Social aos Funcionários e Agentes
da Administração Pública; ADSE) is a public fund for public servants and their
families. Its beneficiaries have dual public health service coverage through the
NHS and ADSE. ADSE provides complementary health care coverage for about
13% of the population and is an important source of revenue for the private
sector. As a result, historically it has been politically difficult to reform ADSE.
ADSE is one of three existing subsystems, the others being Assistência na
Doença a Militares, which provides care to the armed forces, and Assistência na
Doença da Polícia de Segurança Pública, which provides care to police. The AP
stated that the cost of existing subsystems should be reduced by 30% in 2012
and a further 20% in 2013. Further reductions were planned in subsequent
years with the goal that these subsystems will be self-sustainable by 2016. The
costs of these schemes will be reduced by lowering the employer contribution
rate to 1.25% in 2013, increasing employee contributions and adjusting the
scope of health benefits.
Phasing out of fiscal credits for private health care expenditure
In 2012, tax credits for private health care were reduced from a maximum
of 30% to 10% of total personal private expenditure. These tax credits have
now been discontinued for those in the upper income brackets.
3.2 Changes to coverage
Population entitlement
There are few explicit changes to coverage for NHS users. Within the health
subsystems framework, membership of ADSE has been voluntary since 2011.
The benefits package
In accordance with the AP, patient transportation costs were to be reduced by
one-third by the fourth quarter of 2012 compared with costs in 2010; this was to
be accomplished by limiting non-urgent patient transport (e.g. transportation
to therapeutic services/rehabilitation) and specific rules were issued to health