Serviço Nacional de Saúde

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The Serviço Nacional de Saúde ( SNS ; German National Health Service ) is the state health system in Portugal . It is tax financed and is available to everyone who is in the country.

The Hospital de Santa Maria in Lisbon, one of the largest hospitals in the SNS

history

1899-1974

Until 1899 the health system was a private matter, while the state only looked after facilities for the poor. The first state regulation began with the Regulamento Geral dos Serviços de Saúde e Beneficência Pública (German: General Regulation of Health Services and Public Welfare), which was only passed in 1901 and put into service in 1903. In 1945 the inadequate health care was recognized by the state (Decreto-Lei n.º 35108 of November 7th) and the first institutes were created, particularly to combat maternal mortality and tuberculosis . On April 2, 1946, this resulted in a new health system regulation (Lei n.º 2011), which resulted in a number of new hospitals in the country. They were placed under the Santa Casa de Misericórdia , a charitable organization founded in 1498 by Queen Leonor .

In 1958, responsibility changed from the Ministry of the Interior to the Ministry of Health, which was first created with the law of August 13, 1958 (Decreto-Lei n.º 41825). With a new legal regulation of July 19, 1963 (Lei n.º 2120) a responsibility of the state for the creation and maintenance of a nationwide health system was created and placed in the hands of the Ministry of Health, which from now on will control the previous institutions and the creation of those that become necessary had to support larger institutions financially and organizationally. In 1968 the health professions and the requirements of hospitals were uniformly regulated (Decreto-Lei n.º 48357).

In 1971 the idea of ​​a unified public health system arose for the first time in the totalitarian Estado Novo regime of Portugal since 1932 . By law of September 27, 1971 (Decreto-Lei n.º 413/71), the government recognized the right of all Portuguese to health and the obligation of the state to actively ensure this right through its health ministry and with the help of a uniform health policy. In all recognized medical-pharmaceutical areas, the professional groups and their training paths have been specified by the state

The renowned Children's Hospital Dona Estefânia in Lisbon

1974-1993

In 1974, with the Carnation Revolution, a profound political and social change took place in Portugal , as a result of which health policy was now strongly promoted. The constitution of Portugal , passed in 1976, prescribed the creation and maintenance of a comprehensive, general and free national health system through its Article No. 64 (orig .: Serviço nacional de saúde universal, geral e gratuito ). After the reorganization and standardization of the existing institutions, the Serviço Nacional de Saúde (SNS) was introduced by law of September 15, 1979 (Lei n.º 56/79) . It serves all citizens, visitors and refugees in the country regardless of their financial circumstances. Its task is the implementation of the state health policy , including education, prevention , health promotion , rehabilitation and aftercare , etc. a. Its services are free of charge, but a possibility for moderate participation of the users of the SNS is provided as a design tool.

In 1982 the decentralized health administrations of the SNS were re-established (Decreto-Lei n.º 254/82, from June 29th), and the SNS was given full autonomy over administration and finances (Decreto-Lei n.º 357/82, from June 6th). September). On July 25, 1983 (Despacho Normativo n.º 97/83), the SNS was also commissioned to create regional health centers (Centros de Saúde) to supplement and expand health care.

On January 21, 1988, the hospitals of the SNS were legally obliged to adhere to business management principles in their operations, with the law (Decreto-Lei n.º 19/88) establishing the quality of health services as a priority, but at the same time introducing profitability criteria . The SNS was thus adapted by politicians to the simultaneous changes in the remaining EU countries. In this context, Article 64 was amended in 1989 with the second constitutional revision . The right to health is no longer guaranteed by a comprehensive, general and free health service, but rather by a comprehensive, general and, taking into account the economic and social circumstances of the citizen, only tendentially free health service (orig .: universal e geral e, tendo em conta as condições económicas e sociais dos cidadãos, tendencialmente gratuito ). The step was justified with social justice and more efficient use of funds.

On August 24, 1990, the Law on the Principles of Health (Lei de Bases da Saúde, Lei n.º 48/90) established them not only as a right, but also as a joint responsibility of citizens, society and the state. All aspects of health remain the responsibility and control of the state; he can continue to pursue this with his own institutions, but from now on also entrust other participants such as associations or companies with individual tasks , with or without the intention of making a profit . Fees can be levied and must then be paid to the SNS, with exemption regulations for users with higher risk or low income. In 1993, on July 29th (Decreto-Lei n.º 198/95) an identification card was introduced for the users of the SNS, and on September 29th (Decreto-Lei n.º 335/93) the competence structure in favor of the regional SNS- Administrations changed in order to improve the needs-based regional supply.

The Psychiatric Clinic Hospital Júlio de Matos des SNS, in Lisbon

Since 1993

In the years up to 2008, a number of other legislative changes followed, which affected the remuneration regulations for doctors, the administrative relationships between the state and SNS bodies, a more regionalized approach of health care to the place of residence of the citizens, and the introduction of further private-sector instruments. The law of April 2, 2009 (Decreto-Lei n.º 81/2009) made it possible to redefine the terms health and illness in the future, with regard to social, climatic and other changes in the lifestyles of citizens.

In the wake of the financial crisis from 2007 onwards, government grants to the SNS were repeatedly cut or postponed in its various areas, leading to increased protests by the medical profession, SNS users without private alternatives, and increasingly dissatisfied patients due to increasing waiting times and negligent care led by temporary nursing staff. The government referred to a further increased health budget despite the financial crisis. The authors of the SNS also criticized the increasing departure from the original founding idea.

The progress made by the Portuguese health system since the introduction of the SNS, and the associated significant improvements in terms of social justice, are undisputed in Portugal. The Portuguese’s trust in the SNS also remains high.

structure

Global structure

The Serviço Nacional de Saúde (SNS) is responsible for all public health care institutions, in particular

  • all regional health centers ( Centros de Saúde )
  • all public hospitals, regardless of their official name
  • all local health stations ( unidades locais de saúde )

The SNS, for its part, is subordinate to the respective government authority responsible for the area of ​​health, currently the Ministry of Health, which has the overriding supervision and authority over all SNS facilities, regardless of the respective legal form of the facility.

Geographical structure

Continental Portugal is divided into regions in the geographical structure of the SNS, while the two island archipelagos, the autonomous regions of Madeira and Azores, each have their own structure with the Serviço Regional de Saúde , in which the two levels of the health system are integrated.

On the mainland, the two levels are separate. The local health centers, the Centros de Saúde , as the first level of the health system ( cuidados primários ) and the hospitals Hospitais ( cuidados hospitalares ) as the second level, are combined into local units within the regions, the Agrupamentos de Centros de Saúde (group of health centers, some with their own branch offices) and the Centros Hospitalares (hospitals, some with several departments or houses in several locations).

In mainland Portugal there are 363 health centers, some with their own branches, and 212 hospitals, 91 of which are privately owned and four are operated in the controversial form of public-private partnerships , this number has increased since the return of the Braga hospital 3 dropped. The adjacent private practices, the so-called Clínicas , do not belong to this SNS system.

There are five SNS regions on the mainland, largely corresponding to the regions of continental Portugal :

  • Região de Saúde do Norte ( Northern Region ) with 24 Agrupamentos de Centros de Saúde and 16 Centros Hospitalares
  • Região de Saúde do Centro ( Central Region ) with 8 Agrupamentos de Centros de Saúde and 13 Centros Hospitalares
  • Região de Saúde de Lisboa e Vale do Tejo ( Region Lisbon and Tejo Valley ) with 15 Agrupamentos de Centros de Saúde and 16 Centros Hospitalares
  • Região de Saúde do Alentejo ( Region Alentejo ) with 4 Agrupamentos de Centros de Saúde and 6 Centros Hospitalares
  • Região de Saúde do Algarve ( Region Algarve ) with 3 Agrupamentos de Centros de Saúde and 2 Centros Hospitalares

Finances

The SNS is financed from the budget, the annual budget of the Government of Portugal assigns to the health care system. In addition to the allocation from tax funds, this budget is also made up to a lesser extent of other income, for example from the taxa moderadora , a constitutionally permissible deductible for SNS users in the form of practice fees or small deductibles for some operation costs, etc. Lower-income citizens are exempt from the taxa moderadora and from a large part of the prescription fees in whole or in part.

The healthcare system in Portugal is still considered chronically underfunded, especially since the country's deep economic crisis as a result of the euro crisis from 2010. In the course of Portugal's economic recovery, however, the socialist government under António Costa has started to strengthen the SNS financially since 2018, which is carried out annually increased health budgets, backsliding of cuts in health care professionals, and repayment of debt from the SNS. The health budget in the 2020 state budget saw another increase, this time by 942 million euros compared to the previous year, plus special budgets for the modernization of the infrastructure and the strengthening of the SNS.

In 2019, the SNS's total spending was € 10,680.1 million, an increase of around 4.8% over the previous year, with staff costs making the biggest contribution with an increase of 7.4%. A deficit of EUR 620.9 million remained, while the planning had only assumed a deficit of EUR 90 million. According to Health Minister Marta Temido, around 600 million euros were used to settle outstanding claims, otherwise the budget aimed for close to a balanced financial situation for the SNS would otherwise have almost been achieved, according to the minister in January 2020.

literature

A large number of books on the SNS have been published in Portugal that deal with topics such as legal bases, history, scope of services, future prospects or criticism of the Serviço Nacional de Saúde . A small selection of current titles follows:

  • Isabel Silva Ribeiro (Coord.): Histórias da Periferia - Na origem do Serviço Nacional de Saúde. Partenon 2020 ( ISBN 9789898845313 )
  • Raquel Varela (Coord.): História do Serviço Nacional de Saúde em Portugal , Ancora Editora 2019 ( ISBN 978-972-780690-4 )
  • Sofia Leal, Adriana Taveira: SNS, O Tempo de um Renascimento - Contributos para a integração de cuidados de saúde primários e hospitalares. Medicabook 2019 (ISBN)
  • Isabel do Carmo (Coord.): Serviço Nacional de Saúde em Portugal - As ameaças, a crise e os desafios do futuro. Edições Almedina 2012 ( ISBN 978-972-404822-2 )
  • Jorge Simões: 30 Anos do Serviço Nacional de Saúde Edições Almedina 2010 ( ISBN 978-972-404110-0 )

Web links

Commons : Portugal Health System  - Collection of Images, Videos and Audio Files

Individual evidence

  1. ^ Historical data on the Ministry of Health website , accessed on September 9, 2012
  2. ↑ www.ordemdosmedicos , accessed on September 9, 2012
  3. ↑ www.opolvodanoticia.com ( Memento of the original from September 27, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. , accessed September 9, 2012 @1@ 2Template: Webachiv / IABot / www.opolvodanoticia.com
  4. ↑ www.portugal.gov , accessed September 9, 2012
  5. ↑ Interview with A. Arnaut, Minister of Health 1978 , accessed on September 9, 2012
  6. ↑ Article from December 12, 2009 ( Memento of the original from May 18, 2015 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. of the Diário de Notícias newspaper , accessed on September 9, 2012 @1@ 2Template: Webachiv / IABot / www.dn.pt
  7. ↑ www.min-saude.pt , accessed on September 9, 2012
  8. ^ Health website on the Government of Portugal's 2020 budget website, accessed April 8, 2020
  9. ↑ Ministra reconhece que redução do défice no SNS ficou aquém e frisa despesa com pessoal - "Minister acknowledges that the SNS deficit has fallen short of expectations and highlights staff costs" , article of January 24, 2020 of the online newspaper Observador, accessed on April 8, 2020