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Chapter 9 | The impact of the crisis on the health system and health in Portugal
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A report by the Portuguese Health Regulatory Agency (2013b) based on a
sample of 79 NHS primary health care organizations found that the average
number of monthly medical attendances decreased between 2011 and 2012 by
9.2% (10.8% reduction for the less affluent who are exempt from user charges;
6.4% reduction for the non-exempt). Primary health care visits that did not
require a medical consultation increased by 10%, but this increase was only
observed for those exempt from user charge. This report also confirms the low
contribution of user fees to health care financing in Portugal: 0.74% of NHS
revenues in 2010, 0.95% in 2011 and 1.7% in 2012 came from user charges.
There was a slight increase in NHS-financed drug purchases between 2011 and
2012, associated with a substantial fall in both public and private expenditures
on pharmaceuticals (Infarmed, 2013). However, there are some indications that
certain patients are having difficulties accessing the drugs they need. It has been
reported (expert panels) that the types of prescribed drug that patients more
often fail to acquire are those associated with chronic conditions, such as those
aimed at lowering cholesterol and hypertension, as well as antidepressants.
Patients who cannot pay for prescribed medication are increasing and “this is
a worrying situation that many health professionals feel in their workplaces”
according to the President of the Social Services Professional Association in
March 2013 (Carvalho & Rodrigues, 2013). In 2010, a law that granted a
100% state subsidy for antipsychoticdrugs and other drugs associated with
the treatment of a few serious mental health illnesses (such as schizophrenia,
dementia, autism, major depression and bipolar disorder) was discontinued.
These patients now have to pay 5–10% of the cost of treatment.
In May 2010, relatively early in the crisis, a Eurobarometer survey (European
Commission, 2010) on monitoring the social impact of the economic crisis
through public perceptions reported that 61% of Portuguese respondents
stated that their ability to afford health care decreased during the past six
months, compared with 79% of Greeks, 35% of Irish, and 7% of Swedes.
In a 2009 Portuguese survey on mental health, 22% of respondents declared
non-adherence to treatment for financial reasons, with the most commonly
skipped drugs being antidepressants, followed by antipsychotic drugs. This
impact was higher in low socioeconomic classes (Frasquilho & Frasquilho, 2011).
In May 2012, among 980 Portuguese families surveyed on their well-being
during the economic crisis (SEDES, 2012), 22.2% of respondents stated that
they had had to reduce health care expenditures. For families with one or more
members unemployed (20% of the families surveyed), 39.9% reported that
they reduced health care expenditures.
Another study investigated the reported health care-seeking behaviour of the
Portuguese population over 15 years of age (Pita Barros et al., 2013). Two