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

Portugal
Leonor Bacelar-Nicolau, Patrícia Barbosa and Constantino Sakellarides
Economic trends
• Portugal's real per capita GDP, which prior to the crisis was below the
European mean, contracted in 2009 and failed to make a sustained
recovery by 2011. The budget deficit increased markedly in 2009.
• The unemployment rate has risen since 2008, and by 2011 was above the
European mean.
• In 2011, 10-year bond rates increased substantially to over 10%; unable
to borrow on international markets, the government subsequently
requested a bailout package from the IMF and the EU, which required
austerity measures to be put in place.
• The size of government expenditure has decreased during the crisis, as
has the priority for health spending. Public per capita spending on health
did not grow in 2010 and declined in 2011 by 6.4%. Growth in OOP
expenditure has remained relatively stable (Portugal: Figs 1 and 2).
Policy responses
Changes to public funding for the health system
• Public spending on health fell by 6.2% in 2011 and 6.7% in 2012 but
remained stable in 2013.
• The government's comprehensive reform package was expected to
generate savings of €700 million in 2011 and €200 million in 2012 (the
latter by cutting operational costs by 10%).
• A special allocation of €2 billion was made to reduce the NHS deficit
by two-thirds (2012); legislation was passed to limit the NHS deficit in
future (2012).
• The government introduced MoU-stipulated changes to ADSE (covering
public sector workers), including an annual increase of 0.1 percentage
points in the contribution of pensioners (currently 1.3%) to match the
1.5% contribution of civil servants (2011).
• Tax relief for private health spending was abolished for people in the top
two income brackets and reduced from 30% to 10% of total personal
private expenditure for everyone else (2012).