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Jorge Simões President of the Board Porto, 8 May 2014

The Portuguese health system and its regulation. Jorge Simões President of the Board Porto, 8 May 2014. The Portuguese health system Challenges for the health system The Health Regulation Authority (ERS). Outline. I. The Portuguese health system. General characterization

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Jorge Simões President of the Board Porto, 8 May 2014

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  1. The Portuguese health system and its regulation Jorge Simões President of the Board Porto, 8 May 2014

  2. The Portuguese health system Challenges for the health system The Health Regulation Authority (ERS) Outline

  3. I. The Portuguese health system General characterization • The Portuguese health system is characterized by three layers: • The National Health Service • Public insurance schemes for certain professions (health subsystems) • Voluntary private health insurance • The Portuguese health system is a mixed system, with a combination of public and private funding, and also public and private provision

  4. I. The Portuguese health system Public and private mix in funding Current expenditure in healthcare, Portugal 2012 Source: INE (2013), Health Care Satellite Account (2012)

  5. Public and private mix in provision I. The Portuguese health system Proportion of total consultations in private providers, Portugal, 2005 Source: Simões, Barros and Pereira (2008)

  6. I. The Portuguese health system Access and equity • Primary health care: • only 0.03% of the population lives more than 30 minutes away from a NHS primary care facility (ERS, 2009) • 85.2% are assigned to a family doctor (ACSS, 2010) • Hospital care: • 88% of the population lives less than 30 minutes away and only 1% of the population lives more than 60 minutes away from a hospital • asymmetries in the concentration of medical specialists, which is higher in the region of LVT and lower in Alentejo and Algarve

  7. I. The Portuguese health system Access and equity • Vaccination: • immunization rates above 90% and inclusion of new vaccines in the National Plan of Vaccination • Dental Care Programme • Set up in 2005 within the NHS, covers basic dental care for children, aged people with economic difficulties, pregnant women and HIV positive individuals

  8. I. The Portuguese health system Health gains • From 2000 to 2012: • life expectancy at birth increased from 76.4 to 79.9 years; • under 1 year mortality rate decreased from 5.5 to 3.4‰. Source: INE (2013)

  9. I. The Portuguese health system Expenditure on health Portugal – 10,2% OCDE average – 9,3% Expenditure on health as % of GDP Source: OECD, Health Data 2012

  10. The Portuguese health system Challenges for the health system The Health Regulation Authority (ERS) Outline

  11. II. Challenges for the health system • Demographic context • Economic context • Financial sustainability • Europe • Regulation

  12. 1) Demographic context 15% of residents in Portugal are aged under 15 years and 19% are over 65 years (INE, 2012) In the last decade (2001-2011): old-age dependency ratio increased (24.5 to 29.0) natural growth rate became negative (0.07 to -0.06) total fertility rate decreased (from 1.46 to 1.37) (INE, 2012) life expectancy at birth increased from 76.4 to 79.7 years Forecast for 2020: a 2% decrease in population, a 13.8% decrease in youth (0-14 years) and a 20.6% increase in elderly (≥ 65 years). II. Challenges for the health system

  13. 2) Economic context II. Challenges for the health system Gross Domestic Product, Portugal GDP (prices of 2006) Growth rate GDP in million of EUR Real growth rate of GDP Source: INE, 2013

  14. II. Challenges for the health system 3) Financial sustainability “Memorandum of Understanding” signed with IMF and EU, for the health sector, sets: • revision of existing user fee exemption categories (more 150 M€ in 2012 e 50 M€ in 2013) • reduction in public expenditure on drugs (1.25% of GDP in 2012, 1% of GDP in 2013) • hospitals costs: reduction in operational expenditures of 200 million euros (in 2012) • reduction in budgetary costs of public subsystems (ADSE, ADM and SAD) by 30% in 2012 and 20% in 2013, achieved by reducing the benefits to users • reduction in expenditure of the NHS with the acquisition of private diagnostic and therapeutical services in 10% in 2012.

  15. II. Challenges for the health system 4) Europe • EU Directive on cross-border healthcare: • facilitate access to cross-border healthcare in the EU

  16. II. Challenges for the health system 5) Regulation • Financial pressure in health care generates risks to patients: • Management of health care units increasingly oriented by financial targets • Performance targets may collide with patients rights and interests • Containment of global investment on health • Health regulator is essential to balance sustainability measures and ensuring patients rights and interests

  17. The Portuguese health system Challenges for the health system The Health Regulation Authority (ERS) Outline

  18. III. The Health Regulation Authority Who we are Mission of the Health Regulation Authority (ERS) • Regulating the activity of health care providers in Portugal (drugs and medical devices are excluded) Nature • ERS is an independent public body Juridical regime • Decree-Law no. 309/2003 – creation of ERS • Decree-Law no. 127/2009 – restructuring • Decree-Law no. 66/2014 – restructuring under the new framework law for independent regulation in Portugal

  19. III. The Health Regulation Authority Who we regulate • All health care providers, public, private for-profit and private not-for-profit ownership • All types of providers • Hospitals • Individual physician's offices • Outpatient care clinics • Diagnostic tests providers • Dentist offices and clinics (…)

  20. III. The Health Regulation Authority What we do The ERS aims at delivering independent assurance about: • the compliance with the legal requirements for health care services and establishments, • the protection of health care service users rights, including access and freedom of choice, • the legality and transparency in the economic relations between providers, funders and users, • fair competition in health care markets.

  21. III. The Health Regulation Authority How we do it ERS carries out several regulation and supervision activities: • registering and licensing health care providers, • handling complaints from service users, providers and institutions, • carrying out inspections and audits to heath care provider facilities, • carrying out investigations of situations with significant adverse impact on the rights of patients or on the quality and safety of care, • conducting administrative offence procedures involving health care providers and applying the resulting sanctions, • producing studies, advice papers and recommendations, • assessing the quality of health care (SINAS)

  22. III. The Health Regulation Authority Providers registered with the ERS

  23. III. The Health Regulation Authority Complaints handled in 2013

  24. III. The Health Regulation Authority Investigations initiated in 2013

  25. III. The Health Regulation Authority Inspections carried in 2013

  26. III. The Health Regulation Authority Administrative offence procedures initiated in 2013

  27. III. The Health Regulation Authority Studies, advice papers and recommendations (2012/2013) Topics of analysis: • Quality of health care (4) • Inequalities in access to health care (5) • Competition in health care markets (4) • Regulation of economic relations (2) • Patient rights safeguarding (4) • Organization and performance of the NHS (4)

  28. III. The Health Regulation Authority Our people The Board • ERS is managed by a Board of three members (one of which is the president) • Appointed by the Government for a period of 5 years Staff • 51 permanent employees • external experts (doctors, nurses, dentists)

  29. III. The Health Regulation Authority Independence • Independence of Board members • Cannot be dismissed (except in cases of serious failure) • Cannot be involved in regulated activities • 100% funded from registration fee income • Public accountability • Reporting activities to the Parliament and the Government • Advisory board • Activity is overseen by Court

  30. III. The Health Regulation Authority With whom we network • Professional associations • Patient associations • Health care providers • Government health related institutions • Regulators of other sectors • Academic institutions and experts • European health care regulators (EPSO)

  31. III. The Health Regulation Authority Impact of ERS activity • Better knowledge of the health system – registration, sectoral studies; • Greater empowerment of citizens – complaints and information; • Better assurance of user rights – control of access rights; • Better knowledge of health care markets – competition studies; • More safety – licensing, supervision and sanctioning; • More quality – quality assessments and studies.

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