Health system overhaul

Health system overhaul

Just before Christmas, prime minister António Costa’s ‘right hand’ in parliament, economy minister Pedro Siza Vieira, resurrected the subject of health tourism, declaring the Portuguese health system was “one of the best in the world”. In an end of year marked by ongoing strife in the sector and the birth of a baby with ‘no face’, Siza Vieira’s remarks were seen as coming from a parallel universe of hype. But the holidays were almost upon us, and somehow he got away with it.

Hype, however, does indeed appear to be the name of the game for 2020 – with the government insisting it means to make huge strides in the SNS ‘free’ healthcare system, and reverse all the problems of the last decade with the help of almost a billion euros in cash.

Can it be done? How quickly can it be done? Or is it simply the propaganda that opponents say it is?

Health minister Marta Temido has been answering questions in a week when yet another ‘disgrace’ filled column inches: the death of a child taken twice to a respected private hospital enjoying protocols with the SNS health system, but which failed to detect a ruptured spleen. Indeed, the attending doctor is understood to have interpreted the child’s symptoms as ‘a cry for attention’, without having ordered specialist exams.

The death of 12-year-old Leonor Martinho “occurred at a time when the casualty department at CUF Almada was busier than usual due to the nighttime closure of Hospital Garcia de Orta’s paediatric casualty service”, said reports.

“Perhaps, had the (Garcia de Orta) casualty been open, Leonor’s mother would have gone there, and the death would have been avoided,” Roque da Cunha, secretary general of the independent syndicate of doctors, mused.

Whatever the case, the scenario doesn’t gel with “one of the best health systems in the world” – and no one is taking bets that tragedies will suddenly screech to a halt because the government has decided, finally, to make healthcare its priority.

Back in 2014, the then centre-right executive’s plan was to ‘put Portugal on Europe’s healthcare map’ by offering packages to foreigners and so potentially attracting €400 million of business per year.

The target group appeared to be Brits, Germans and French – with what was dubbed ‘Health Cluster Portugal’ powering the way forwards.

Since then, almost nothing has been reported on the plan – until Siza Vieira’s remarks on December 18 at the signing of a new protocol between representatives of Turismo de Portugal, AICEP, the Portuguese agency for investment and external commerce, Health Cluster Portugal (yes, it still exists) and the Portuguese association of private hospitalisation.

The document described “medical tourism as a potential vector of competitiveness in the sector and established the objective of reaching a yearly volume of business superior to €100 million”.

In five years, the potential for €400 million-worth of healthcare business had been slashed by three-quarters.

So, what really are the plans? In a long interview with TSF radio, valiant health minister Marta Temida said that she views the government’s zeal to improve her service as “an opportunity that must be grabbed”.

“Health is a priority, not just of Portuguese people but all Europeans. Thus, it is incumbent on states to respond positively to this concern – and this is what we are trying to do,” she said.

Focus will be on “improving management” so that healthcare professionals are more motivated and the system revitalised.

Temido didn’t for one minute suggest that the way forwards will be easy – but she equally didn’t refer to the vast swathes of society that have essentially turned their back on the SNS system because it doesn’t work.

An opinion column in ECO online this week, penned by economist Luís Filipe Pereira, explains that as many as 40% of the population now is covered by private health insurances, implying that these people’s access to ‘one of the best systems in the world’ is probably vastly superior than that of those whose salaries do not allow for monthly healthcare instalments.

The ‘good news’ for 2020 is that over 8,400 new members of staff are to be hired – only 1,000 of them likely to be nurses.

Temido told TSF radio that the bulk of new contracts will go to ‘senior diagnostic and therapeutic technicians (“one of the groups most lacking right now in the SNS”) and operational assistants.

“Full dedication” is the term the minister used for trying to power a spirit of exclusivity within the State service – and for this to work, teams are to be given “greater autonomy” and receive “rewards for efficiency”.

In this latter regard, the idea is to relieve waiting lists.

As Luís Filipe Pereira explained, 15 years ago, expenses on the health system were in the region of €7.5 billion – and surgical waiting lists numbered around 123,000 patients. In 2019, money spent was up by almost another €5 billion, and surgical waiting list numbers had almost doubled.

Marta Temido is positive, nonetheless. She told TSF: “We work every day to respond to people, and it is worth stressing that our contact with people shows we are closer to responding positively to their expectations than news reports imply.”

Doctors call on opposition MPs to ‘help save the SNS’
Medical syndicates started meeting with MPs in opposition this week, with a view to getting their support to bring the government to the negotiating table and ‘save the SNS’.

FNAM, the national federation of doctors, and SIM, the independent syndicate of doctors, is targeting the centre-right PSD, PCP communists and left-wingers Bloco de Esquerda, asking them to “help make the government aware” of problems which it’s not talking about.

Far from subscribing to the opinion that this country runs one of the best health systems in the world, the doctors say they are concerned that Portugal is behind when it comes to European standards and ‘must step up its game’.

One of the concerns is ‘safety in the workplace’ following a vicious attack on a female doctor in Setúbal over New Year.

Attacks on medical staff are often motivated, say doctors, by the long waiting times endured by frustrated patients.

The meetings will continue into the middle of January when slots have been confirmed with centre-right CDS and PAN (Peoples Animals Nature party).

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