restricted the coverage of some types of
treatment, particularly dental care.
Veneto Region went through a reform reducing
the number of Trusts from 21 to nine. The impact
of such reform was important because this
resulted in a new distribution of competences.
The Zero Trust centralised all the administrative
functions such as nursing recruitment, large
procurement, regional education and health
technology assessment. The centralisation of ICT
services offers a new important challenge for
storing and managing health and organisational
information in a unique digital archive.
involvement of professionals holding managerial
responsibilities; and increase NHS professionals’
productivity and satisfaction levels, linking the
institutional and financial incentives allocation
to the performance effectively achieved. 6
Affordable and quality palliative care 7
The Strategy for the Development of Palliative
Care resulted in a National Network of Palliative
Care, integrated in the NHS and implemented at
all levels of healthcare.
Digital transformation (E-Health)
In 2017, the National Strategy for Health
Information Ecosystem 2020 was approved, 8
which aims to increase citizens’ interaction with
health technology. To this end, it provides the
availability of multiple digital service platforms
that allow information access and sharing, but
also the simplification and informatisation of
registries and processes in the NHS till 2020 such
as E-Prescription, Electronic health record, Portal
SNS 9 and mobile applications (MySNS, 10 MySNS
TEMPOS, 11 MySNS CARTEIRA 12 ).
PORTUGAL
Mr Carlos Pereira Alves
HOPE Governor, Portuguese Association for Hospital
Development
Clinical Academic Centres and University
Hospitals
In 2018, Clinical Academic Centres were created
and pilot projects of University Hospitals were
established. 13 Clinical academic centres are
consortiums and associations of healthcare units
(for example, hospitals), higher education
institutions (for example, universities) and/or
research institutions (public or private). These
centers are dedicated to the promotion of
integrated healthcare, teaching, clinical research
and translation. With the pilot projects of
university hospitals, some established university
hospital centres were reorganised to improve
their working processes and functions.
Could you describe the last hospital and/
or healthcare reforms implemented in your
country in the past 5 years?
Primary healthcare reform 4
In recent years, the Primary Healthcare Network
has been strengthened and expanded, through
the deepening of the Primary Health Unit’s model
and performance, with the objective of increasing
the NHS response and assigning a family health
team to all residents.
Integrated responsibility centres
In 2018, the model of Integrated Responsibility
Centres (CRIs) that are organic intermediate
management structures, dependent on the NHS
public entities boards of directors was defined. 5
The CRIs have functional autonomy and establish
an economic and financial assistance
commitment, following the presentation of an
action plan that defines the healthcare
programme for a period of three years. The CRIs
are created to ensure the development of best
clinical practices focused on the users’ needs;
foster clinical governance processes and therefore
care quality improvement; increase the
accessibility and timely response of the NHS to
citizens; mobilise the installed capacity in the
NHS public network; promote the autonomy and
Could you present two/three elements on
the impact of such reforms on hospital and/
or healthcare sectors that your organisation/
country has identified?
The reinforcement and expansion of the Primary
Healthcare Network significantly improved
primary healthcare, in terms of accessibility and
quality. On one hand, this is visible by the
increase in the number of Portuguese with family
doctor (93 % in 2017); and on the other hand, by
the number of medical appointments, which is
over 30 million per year. In January 2018, the
highest number of physicians, nurses and
diagnostic and therapeutic technicians, working
in the NHS, in the last ten years was registered.
PORTUGAL
Total current health expenditure as % of Gross Domestic Product (GDP)
General government/compulsory current health expenditure as % of total current health expenditure
Hospital current health expenditure, as % of total current health expenditure
Household out-of-pocket health expenditure as % of total current health expenditure
All hospital beds per 100,000 inhabitants
Acute care hospital beds per 100,000 inhabitants
Acute care admissions/discharges per 100 inhabitants
Average length of stay for acute care hospitals (bed-days)
Practising physicians per 100,000 inhabitants
Practising nurses per 100,000 inhabitants
20
HHE 2019 | hospitalhealthcare.com
2002
8.6%
72.6%
38.1%
22.6%
357.0
351.0
11.1
7.2
n.a.
n.a.
2008 2016
9.4%
9.1%
68.4%
66.4%
38.3%
42.2%
25.8%
27.8%
339.0
342.0
333.0
329.0
11.3
10.8
6.8
7.2
n.a.
n.a.
n.a.
n.a.