Table 2.

Key areas of MoU’s health care reforms and austerity measures in the National Health Service (NHS), Portugal

Pharmaceuticals	Reduction in public spending
	▪ Revision of pricing system, price reduction in expenditure for Pharmaceuticals
	▪ Reduction in the regulated price increase rates for pharmacies
	▪ Reinforcement in compulsory prescription (INN prescription) of generic medicine
	▪ Formation of intensive monitoring mechanisms with evaluation and response to physicians and pharmacies
	▪ Introduction of clinical guidelines
	▪ Compulsory electronic-prescriptions (e-prescriptions) by active substances for consistent monitoring, evaluation and reporting
Primary care services	Reinforcement of provision and efficiency of the Primary care services
	▪ Equal allocation of general practitioners (GPs) throughout the country ▪ Restructuring of Health care units (ACES) into family health units ‘Unidades de Saúde Familiares’ (USFs)
	▪ Wages and services associated payments
	▪ Introduction of electronic platform of medical records assessed by primary care providers and hospitals
	▪ Increase of the number of USFs to achieve an even geographic distribution of GPs
Hospital care services	Centralization and Reorganization of public hospitals: Attainment of savings in operational costs
	▪ Merger of several hospital outpatient services to primary care units
	▪ Staff reallocation, rationalization of resources and facilities ▪ Management of staff working hours: Decrease in staff overtime compensation
Co-payments	Increase in NHS co-payments – user fees, ‘taxas moderadoras’
	▪ Revision of the of the NHS cost-sharing schemes (co-payments) to reinforce Primary care usage [see Table 5]
	▪ Automatic Indexation to Inflation of co-payment taxes
General healthcare cost reduction	▪ Fundamental revision and adjustment of accompanying exemption rules for healthcare payment
	▪ Reduction in tax allowances for healthcare expenditure by two thirds (incl. Private insurance expenses)
	▪ Revision in provision and purchasing procedures to accomplish savings by centralising procurement (i.e. reduction in transaction costs)
	▪ Cuts in non-emergency transportation to healthcare facilities

Based on: European Commission. The economic adjustment programme for Portugal. Brussels: European Commission; 2011 [24]