by Michael Tanner
Director of Health and Welfare Studies
The Cato Institute
Washington, DC
mtanner@cato.org
Portugal
The Portuguese health care system is a classic, universal, centrally run
National Health System—a single-payer system funded through taxes with comprehensive benefits provided free or at little cost at the point of service. 1 Also, a
number of occupation-related health insurance schemes—originally intended to
be integrated into the NHS—now coexist with it.
The primary source of care is the NHS, which is funded primarily through
general tax revenues, accounting for approximately 13% of all government expenditures. 2 In theory, the NHS operates within an annual global budget for
health care spending. In reality, it regularly exceeds this budget by a wide margin, necessitating supplemental funding. Portugal is one of the few OECD
countries where public health care spending has been rising as a proportion of
total health spending, up more than four percentage points since 1997.3
Theoretically, benefits under the NHS include all necessary inpatient and
outpatient health care services, including specialists, diagnostic tests, mother
and child care, and prescription drugs. On paper, no health-related expense is
specifically excluded from coverage by the NHS though, in reality, services such
as dental care and rehabilitation therapy are seldom provided. 4 Copayments are
required for diagnostic tests, hospital admissions, consultations with specialists
and prescription drugs, where copayments can run to 40% or higher. 5
Primary care physicians and hospital-based physicians are public employees,
paid directly by the NHS. However, NHS doctors are permitted to practice privately as well, and roughly half of them do so. 6 Specialists are often in private
practice and are reimbursed by the NHS on a contractual basis.
Editor’s Note: This is the last article in
the series that examines the health care systems of other countries. We’d like to again
thank the Cato Institute for allowing us to
run these excellent articles. If you’d like to
see the entire report, visit www.cato.org.
About 25% of the population (mostly government workers, military, telecommunication workers and their families) remain under a series of industry- or oc-cupation-based insurance schemes known collectively as “subsystems,” which
are a legacy of the country’s pre-NHS health care system. 7 These plans were originally intended to be incorporated into the NHS, but their powerful constituen-cies have prevented that from occurring. Participants in the subsystems pay a
premium equal to approximately one percent of their salary. Benefits are generally superior to those offered through the NHS. 8 Not surprisingly, premiums
