Portugal: #17 in the 2021 World Index of Healthcare Innovation

Introduction

Portugal ranks 17th in the 2021 World Index of Healthcare Innovation, up from 21st in 2020, with an overall score of 46.92. The Iberian nation is a top-tier performer in Quality (#3, 63.15), garnering high marks for patient-centered care and health outcomes.

Portugal’s ranking was hampered by poor scores for Science & Technology (#28, 15.80) and Fiscal Sustainability (#20, 49.93). Portugal is not a major engine of scientific discovery, and its debt-to-GDP ratio of 128% is the third-highest among WIHI countries, only behind Japan and Greece.

Background

The modern Portugal health care system was founded in 1979 with the establishment of the Portuguese National Health Service. While the Portuguese NHS was originally designed as a single-payer system, private insurers began to emerge within a few years.

Today, Portugal has a hybrid public-private health insurance system. A majority of the population is enrolled in public insurance through the Portuguese NHS, but a quarter are enrolled in private insurance, either through a professional association or the individual market. Private insurers in Portugal enjoy more regulatory freedom than do American insurers in terms of benefit design.

The Portuguese NHS directly negotiates drug prices for its enrollees, and also uses external reference pricing (benchmarking Portuguese prices to those of other countries) as a tool.

Quality

The quality of Portugal’s health system ranked well in the WIHI analysis, compositing a third overall ranking. In particular, Portugal ranked 3rd in patient-centered care — notably higher than its Iberian Peninsula counterpart (i.e., Spain ranked 24th). Additionally, the country’s medical infrastructure ranked third.

Choice

Portugal ranked 11th for overall patient choice. Notably, its high cost of health insurance held the country back (27th), even with strong metrics in access to new medical technologies (11th) and patients’ abilities to choose health care services (12th).

Science & Technology

Portugal ranked in the bottom tier (28th) of the WIHI analysis in science and technology. Notably, its low rate of EHR adoption (dead last) ranked considerably lower than its European counterparts (for instance, Spain ranked 17th in this category). Additionally, Portugal’s contributions to medical innovation (20th) and scientific innovation (24th) were lower than expected.

Fiscal Sustainability

Portugal’s fiscal sustainability ranked 20th overall. In particular, Portugal’s debt-to-GDP ratio (29 of 31) affected the country’s overall ranking. Yet, there are signs of hope. Portugal’s growth of health spending as a share of its GDP over the last decade ranked 3rd lowest overall, making it likely that Portugal improves its overall sustainability ranking over time.