Table 2. Measures by health system function, extracted from political manifestos ahead of Portugal’s snap general election in March 2024.
| Function | Measure | Party |
|---|---|---|
| Governance | ||
| Role of private providers | To reintroduce public–private partnerships in national health service hospitals | Iniciativa Liberal |
| To outlaw public–private partnerships in national health service public hospitals as well as type C family health units (privately-owned primary care physician groups contracted to provide care for national health service patients) | Bloco de Esquerda | |
| To outlaw type C family health units | Partido Comunista Português | |
| Electronic health records | To implement integrated health information systems: establishing a unified digital platform and universal electronic health records | CHEGA |
| Governance of public hospitals and the national health service board | To revise the national health service statutes, specifically by eliminating the role of national health service chief executive officer | CHEGA |
| To restructure the national health service executive board, streamlining its organizational structure and redefining its functional responsibilities | Aliança Democrática | |
| To implement a top-down governance model for the national health service, with the national health service executive board at its core | Partido Socialista | |
| To promote democratic administration in national health service providers by introducing competitive recruitment for both hospital and primary care units’ chief executive officers, and allowing the workforce to elect their managers | Partido Comunista Português | |
| Health system performance monitoring | To conduct regional and national audits of waiting time targets across the [national health service] hospital network | Aliança Democrática |
| To strengthen health system performance monitoring by resorting to public reporting of key indicators | Partido Socialista | |
| Financing | ||
| Pay-for-performance | ||
| Primary care | To foster the rollout of type B family health units (national health system-owned primary care physician groups contracted using pay-for-performance to provide care for national health service patients) | Iniciativa Liberal |
| To reward the health workforce based on the quality of treatment and outcomes instead of activity-based payments | Partido Animais e Natureza | |
| Hospital care | To offer additional monetary incentives (within the Sistema Integrado de Gestão de Inscritos para Cirurgia, the national health service surgical waiting list) based on patient-reported outcome measures | Aliança Democrática |
| Purchase of care from private providers | To issue specialist appointment vouchers, allowing patients free choice of provider when national health service waiting time targets are exceeded | Aliança Democrática |
| Expanded financial protection | Zero value added tax on menstrual hygiene products | Partido Animais e Natureza |
| Expanded coverage | Full drug coverage for individuals with income below the national minimum wage (in 2024: €11 480 annually) | Bloco de Esquerda |
| Resource generation | ||
| Workforce planning, availability and distribution | To ensure maternal health professionals receive pregnancy, childbirth and postpartum human rights training provided by the specialty colleges of the nursing and medical societies | Iniciativa Liberal |
| To guarantee fair remuneration and career progression for healthcare professionals by: revising salary grades; creating a system of individual or group incentives; reimbursing travel expenses for appointments more than 100 km away; recognizing the medical and nursing professions as high-risk and rapid burnout occupations | CHEGA | |
| To establish a health-care professional motivation plan to recognize the value of all human resources involved in health-care provision, especially in the national health service. This plan will comprise incentives, career development, flexible working hours, professional differentiation and new skill profiles | Aliança Democrática | |
| To offer incentives to the workforce in underserved areas: housing and family support, professional development, telemedicine, and integration into multidisciplinary teams | Partido Socialista | |
| To encourage full-time employment with non-compete agreements while working for the national health service by ensuring career progression and professional development, redirecting incentives towards this goal | Partido Socialista | |
| To establish full-time employment with non-compete agreements for physicians and nurses while working for the national health service | Partido Animais e Natureza | |
| To hire nutritionists for all national health service primary care units | Partido Animais e Natureza | |
| To establish full-time employment with non-compete agreements with a 40% higher salary and 50% additional career progression points | Bloco de Esquerda | |
| To reduce a physician's national health service minimum emergency care work week to 12 hours, freeing up time for appointments and surgeries | Bloco de Esquerda | |
| Generation and the upkeep of infrastructure and medical equipment | To equip the larger national health service primary care units with laboratory and diagnostic tests procedures facilities | Partido Socialista |
| To equip the larger national health service primary care units with laboratory and diagnostic tests procedures facilities, namely for radiographs and electrocardiograms | Bloco de Esquerda | |
| To promote the upkeep of national health service infrastructure by: assessing which hospital facilities require urgent renovation; investing in the construction of new buildings | Livre | |
| Service delivery | ||
| Care provision for a target population | To prioritize the assignment of family doctors to pregnant women, children younger than 9 years and adults older than 65 years | Iniciativa Liberal |
| To expand HIV pre-exposure prophylaxis appointments to national health service primary care units and enable the dispensing of HIV-related drugs at community pharmacies | Iniciativa Liberal | |
| To implement chronic patient case management for frequent emergency department users | Aliança Democrática | |
| To deliver emergency and long-term care to elderly people through nurse teams that provide home visits and through home delivery of medication in coordination with local pharmacies | Partido Socialista | |
| Emergency care | To strengthen gatekeeping for direct access to hospital emergency departments by generalizing telephone triage, which will steer users to either primary care or [other] hospital services | Partido Socialista |
| Public health | To conduct a nationwide nutritional quality and obesity risk study in every school and implement a nutritional and physical activity programme, promoted by the national health service primary care units in collaboration with schools and civil society | Partido Animais e Natureza |
| Mental health care | To focus on diversifying mental health responses and implementing a stepped care model; to promote the mental health organization model based on community multidisciplinary teams | Livre |
€: euro; HIV: human immunodeficiency virus.
Note: These are the authors’ translations. The original text for the 350 classified measures is available in Portuguese upon request to the corresponding author.