New tax to bail out debt-ridden health service


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A COMMISSION studying future ways of financing the debt-ridden Service Nacional de Saúde (SNS), the Portuguese national health service, is to recommend a new health tax to avoid the complete bankruptcy of the system.

Shocking new evidence emerged last week from the Tribunal das Contas, the audit department of the exchequer, that the SNS has accumulated a massive eight billion euro debt, with millions owed to medical suppliers and pharmaceutical services.

According to information collected by the Portuguese daily business newspaper Diário Económico, the report recommended a separate tax to fund the health service.

This is just one of the measures proposed in a report to the Ministries of Health and Finances in August last year. The proposals were discussed in a government meeting, where three Ministry of Health and Finance assessors agreed on what recommendations they would make to the government for health service reform.

The document entitled Interim Progress Report said: “In  the case that public finances from the State Budget mean the financing of the SNS is economically unviable, financing will have to be made through obligatory, compulsory contributions based on (individual) income.”

In other words, if the SNS accounts continue to be in the red, the commission will recommend that the government introduces a graduated income solely for the health service.

The commission’s proposals aim to increase SNS receipts, by rationalising the distribution of free benefits and the elimination of all state contributions to health sub-systems.

The commission also will recommend that the criteria for introducing new innovative medicines into hospitals will require a thorough economic-pharmacological case study justifying their clinical and economic effectiveness.

However, critics say that this will mean those that can afford to will go to the private sector where all drugs are available and those who can’t pay will effectively have access to a second-class health system.

Another proposal recommended was the transfer of a fixed amount of money to a management entity responsible for a fixed quantity of patients.

The commissioners say there should also be defined rules concerning transparency in the health service and concluded that “there would be no advantage in radically altering the financial model of the SNS since applying completely new financial models would be tantamount to dismantling the present national health system.”

The Resident visited a major central Lisbon hospital on January 11, and spoke with nursing staff about working conditions in the Portuguese public health system.


One nurse, who wished to remain anonymous said: “You’ve no idea what it’s like here. We’re stretched to the limit. We have to work in antiquated 18th century hospitals, while they close some down before building new ones capable of delivering a modern and cost-effective service for the 21st century.

“There are scores of clinicians who only check the paperwork of the staff doing the donkey work. They get paid scandalously high salaries for paper-pushing and then earn money privately on the side.”

Another nurse said: “There are doctors, who deliberately prescribe costly brand-name medicines rather than equally effective generics because they are given incentives to do so and paid junkets abroad for themselves and their families for pushing the more costly products.”

On the other hand, they all agreed there were too many chiefs and not enough Indians with a lack of nursing and ancillary staff in many departments at the cutting edge of patient care.

However, the proposals for health service reforms, which are also aimed at the number of doctors, are already gathering momentum from opposition unions such as the Ordem dos Medicos, the Portuguese Association of Hospital Doctors (APMCH) and two leading health unions.

“Instead of degrading and slapping down the value of doctors’ careers in front of the population, the Minister of Health should worry more about the existing structures within the system,” said the Vice President of APMCH, Armando Rocha.

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