Learning from an economic crisis - health system resilience in Portugal

International and domestic economic conditions led to a bailout of Portuguese public finances in May 2011. The bailout had associated a set of commitments to reduce public spending in health care. The speed of adoption of policy measures, and their depth, constituted an unanticipated economic shock to the Portuguese National Health Service. The shock had some permanent and some temporary elements. Most of the shock was composed by price effects (including nominal wage cuts and administrative price reductions to private providers of goods and services). Intended changes in governance and management of the National Health Service were mostly short lived. The shock, in several dimensions, was absorbed, adjusted to for some years, and reverted. In other dimensions, permanent changes were introduced. Finally, in some cases, the adjustment created future difficulties for the National Health Service (namely, associated with human resources). There are lessons learned for both the National Health Service and the external entities that defined the set of conditions defining the economic shock. The Portuguese National Health Service revealed resilience to several aspects of the economic shock, but also an inability to learn in a systematic way from the shock. The adjustment to the economic shock brought permanent changes that improved the functioning of the National Health Service, but also seeds for future problems.