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Country profiles of health system responses to the crisis | Portugal
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• User charges increased for use of hospital emergency departments (from
€3–10 to €10–20); basic emergency, medical–surgical and multipurpose
emergency (from €8.60 to €15, €17.50 and €20, respectively); primary care
services (from €0–5 to up to €10); permanent or extended services (from
€3.80 to €10); GP visits (from €2.25 to €5); nursing services; vaccines not
included in the national vaccination plan; and diagnostic and therapeutic
services (2011).
• Introduction of indexing for user charges so that they rise in line with
inflation and revenue from user charges to increase by €150 million in
2012 and €50 million in 2013 (2011).
• Income-based household exemption from user charges restricted by raising
the eligibiilty threshold from a monthly income of less than €485 to €628
(2011).
• From 2013, user charges for all hospital services are to increase by 2.8%
(matching inflation) (2012).
• Incentives created to enforce payment of NHS user charges.
Changes to health service planning, purchasing and delivery
Prices of medical goods
• Steps taken to remove barriers to entry for generics (2011).
• Reduction of prices for covered drugs (6%), biologicals (7.5%),
supplementary diagnostic tests (5%), medical imaging (3%) and test
strips for diabetics (10%); generic drugs priced high in comparison to
international prices should be at least 35% lower than the original; the
price of first-line generic drugs capped at 60% of the original, later 50%;
original prices to be automatically reduced when patents expire (2011).
• Steps taken to reduce spending on privately provided imaging, laboratory
tests and rehabilitation by renegotiating existing contracts and lowering
tariffs (2011).
• A new agreement set up between the Ministry of Health and the Association
of Pharmaceutical Producers (2012).
• Drug pricing system revised to include three countries of comparable
GDP and countries with the lowest prices in Europe; first applied in the
ambulatory sector and then extended to hospitals (2012).
• Pharmacy margins changed from a constant percentage mark-up to
regressive margins and fixed fees.
• Introduction of new rules making INN prescribing mandatory (2012).