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

Chapter 9 | The impact of the crisis on the health system and health in Portugal
299
These measures had spillover effects. Concerns about the future of young medical
professionals in public service led to a medical strike in July 2012. After the
strike, the Ministry of Health and the medical unions negotiated an agreement,
signed in October 2012, that included changes in remuneration, working
schedules, performance evaluation, new hiring to the NHS (2000 new health
professionals in 2013–2014), career development opportunities, extending GP
patient lists from 1500 to 1900 and extended mobility of physicians within
the NHS. A family nurse project is also being designed with the purpose of
enhancing primary health care, particularly for chronic diseases and long-term
care conditions.
Pharmaceutical policy reforms
Between 2010 and 2011, NHS spending on drugs was reduced by €668 million,
as this area was a priority for savings even before the AP (Directorate-General
of Budget, 2012a,b; Portuguese Observatory on Health Systems, 2012). In
2011, there was a 19.2% decline in NHS expenditure on drugs prescribed in
ambulatory care, accounting for more than €312 million in savings. In 2012,
expenditures continued to decrease by 11.4%. NHS hospital drug expenditures
in 2011 slowed to 1.2% growth, but decreased in 2012 by 1.1% based on
data through to November (Infarmed, 2011; Portuguese Observatory on
Health Systems, 2012) (Table 9.6). In addition, in May 2012, the Ministry of
Health signed an agreement with the Portuguese Association of Pharmaceutical
Industries to reduce public expenditure on drugs by €300 million in 2012,
to ensure more rapid payment by the NHS on accumulated debts owed to
the pharmaceutical industry and to improve access to new drugs in the
Portuguese market.
Table 9.6 Changes in drug expenditure (NHS ambulatory and hospital) as a percentage
of that in the previous year, 2007–2012
Year
Drug expenditure changes in
ambulatory sector (%)
Drug expenditure changes in
hospital sector (%)
2007 −1.7 3.2
2008 5.0 4.9
2009 6.2 9.7
2010 5.2 3.1
2011 −19.2 1.2
2012 −11.4 −1.1 (Jan. to Nov.)
Source: Infarmed, 2013.