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Chapter 9 | The impact of the crisis on the health system and health in Portugal
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6. Conclusions
The current financial, economic and social crisis in Portugal resulted from
a complex interplay of external and internal factors. While the government
implemented a number of austerity measures before 2011, it was the adoption
in mid-2011 of the three-year AP, negotiated with the Troika, that brought
about more severe socioeconomic changes.
The health section of the AP contained a number of measures that had
been called for before the crisis began. These measures were mostly focused
on reducing health care costs, rationalizing the use of health resources and
increasing revenues through mechanisms such as user charges. However, in
many ways the AP did not consider the potential effects of austerity on health
and health care. One of the more significant omissions of the AP was the lack
of early health impact assessment of the crisis and associated austerity measures.
With better monitoring, policy-makers could have designed adequate measures
to minimize negative health effects. Moreover, adopting a transparent approach
would have allowed for more evidence-based assessment of the true impact of
the crisis on health.
Based on the limited data available by mid-2013, there seems to have been
a negative impact of the crisis on mental health and health care-seeking
behaviours, particularly among vulnerable groups. The likely impacts on
alcohol and drug addiction and on acute and chronic conditions are more
difficult to clearly ascertain at present. Moreover, identifying the relative
contribution of impoverishment, increased user charges, transportation
difficulties and unemployment concerns is not possible on the basis of the data
that are currently available. Likewise, budget cuts, salary reductions and adverse
working conditions for health managers and health care professionals are likely
to have negative effects on health care processes.
There are many challenges for Portuguese society in the months and years
ahead. Despite compliance by the government in implementing the AP and
improvements in access to financial markets, public debt has been increasing
substantially; private access to credit remains difficult; unemployment
continues to be high; economic growth prospects are slim; and in this context
the public deficit targets in line with the new European Treaty (Fiscal Compact)
do not seem to be very realistic without further social hardship and cuts in
public expenditure.
Placing health visibly on the public policy agenda, both nationally and at
European level, through a comprehensive approach to public polices, looking
explicitly at the intermingled effects of financial, economic and social policies,
is a fundamental requirement for looking ahead towards a better future.