1 CAPP, Instituto Superior de Ciências Sociais e Políticas, Universidade de Lisboa, Lisbon, Portugal.
2 CERis, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal.
Int J Health Serv. 2019 Apr;49(2):237-259. doi: 10.1177/0020731418822227. Epub 2019 Jan 24.
Portugal has faced an economic and financial crisis that began circa FY2009 and whose effects are still ongoing. In FY2011, the Portuguese state and the European triumvirate - composed of the European Commission, the International Monetary Fund, and the European Central Bank - signed the Memoranda of Understanding. This troika agreement aimed to improve the operational efficiency of public services. This crisis had a considerable impact on the Portuguese citizens' life and productivity, as well as on the public health care system. Cuts over public expenditures have been made to reduce the risk of noncompliance with budgetary targets, despite their potential impact on quality and access to health care services. We analyzed the main policies and measures undertaken by the Portuguese Ministry of Health with respect to the bailout program associated with the troika agreement. Then, we focused on the budgetary cuts-related risks over the social performance of the care system. Evidence suggests that structural reforms in the health care sector in the troika period had positive effects in terms of drugs administration and consumption, on the one hand, and secondary care expenditures reduction, on the other hand. Nonetheless, we observed some divestitures on infrastructures and the worsening of access to health care services.
葡萄牙曾面临一场始于 2009 财年的经济和金融危机，其影响至今仍在持续。2011 财年，葡萄牙政府与欧洲三驾马车（由欧盟委员会、国际货币基金组织和欧洲中央银行组成）签署了谅解备忘录。该三方协议旨在提高公共服务的运营效率。这场危机对葡萄牙公民的生活和生产力以及公共医疗保健系统产生了重大影响。为了降低违反预算目标的风险，公共支出已经削减，尽管这可能会对医疗保健服务的质量和可及性产生影响。我们分析了葡萄牙卫生部在与三方协议相关的救助计划方面采取的主要政策和措施。然后，我们关注了预算削减对医疗保健系统社会绩效的相关风险。有证据表明，在三方协议期间，医疗保健部门的结构性改革在药品管理和使用方面产生了积极影响，另一方面也减少了二级护理支出。然而，我们观察到一些基础设施的出售以及医疗保健服务获取情况的恶化。
