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A Critical Analysis of Decentralizing the Portuguese Public Healthcare Provision Services

Author

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  • Alexandre Morais Nunes

    (Centre for Public Administration and Public Policies, Institute of Social and Political Sciences, Universidade de Lisboa, Rua Almerindo Lessa, 1300-663 Lisbon, Portugal)

  • Diogo Cunha Ferreira

    (Centre for Public Administration and Public Policies, Institute of Social and Political Sciences, Universidade de Lisboa, Rua Almerindo Lessa, 1300-663 Lisbon, Portugal
    CERIS, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001 Lisbon, Portugal)

Abstract

The Portuguese health system has a universal, public, general National Health Service (NHS), tending towards free healthcare access. Created in 1979, this delivery model developed from the integration and complementarity between the different response levels (primary, hospital, continuing, and palliative care). However, over the last 40 years, the initially centralized system underwent a decentralization process with the creation of Regional Health Administrations in the five mainland administrative regions. Since then, the entire NHS has settled around this new organization. The most recent step started in 2018 with the decentralization of primary healthcare skills to 190 municipalities. This paper presents the various critical issues involved in the latest gradual decentralization process in health, intending to bring services closer to the citizens, and to be more focused on their needs. The article identifies and discusses the implications of this experience based on the steps foreseen in the already-published legal texts.

Suggested Citation

  • Alexandre Morais Nunes & Diogo Cunha Ferreira, 2022. "A Critical Analysis of Decentralizing the Portuguese Public Healthcare Provision Services," IJERPH, MDPI, vol. 19(20), pages 1-10, October.
    • Handle: RePEc:gam:jijerp:v:19:y:2022:i:20:p:13390-:d:944563
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    References listed on IDEAS

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    1. Diogo Cunha Ferreira & Alexandre Morais Nunes, 2019. "Technical efficiency of Portuguese public hospitals: A comparative analysis across the five regions of Portugal," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(1), pages 411-422, January.
    2. Alexandre Morais Nunes & Diogo Cunha Ferreira, 2019. "Reforms in the Portuguese health care sector: Challenges and proposals," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(1), pages 21-33, January.
    3. Alexandre Morais Nunes & Diogo Cunha Ferreira, 2019. "The health care reform in Portugal: Outcomes from both the New Public Management and the economic crisis," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(1), pages 196-215, January.
    4. Saltman, Richard B. & Bankauskaite, Vaida, 2006. "Conceptualizing decentralization in European health systems: a functional perspective," Health Economics, Policy and Law, Cambridge University Press, vol. 1(2), pages 127-147, April.
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    Cited by:

    1. Gonçalo Santinha & Alexandre Fernandes & Rafaela Oliveira & Nelson Pacheco Rocha, 2023. "Designing a Health Strategy at Local Level: A Conceptual Framework for Local Governments," IJERPH, MDPI, vol. 20(13), pages 1-22, June.
    2. Alexandre Nunes, 2024. "Vertical Integration in Healthcare and Patient Satisfaction: An Exploratory Analysis of Portuguese Reforms," Sustainability, MDPI, vol. 16(3), pages 1-16, January.
    3. Emmanuel Achiri & Mustapha D. Ibrahim, 2022. "Efficiency Analysis of Syrian Refugees’ Healthcare Services in Turkey and Other 3RP States," IJERPH, MDPI, vol. 19(22), pages 1-16, November.

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