Portugal: #22 in the 2022 World Index of Healthcare Innovation
Portugal’s partly private system boasts excellent quality, but struggles to find a sustainable fiscal footing and stimulate medical innovation.
By Gregg Girvan, Grant Rigney, and Avik Roy
Introduction
Portugal ranks 22nd in the 2022 World Index of Healthcare Innovation, down from 17th in 2021 and 21st in 2020, with an overall score of 44.23. The Iberian nation is a top-tier performer in Quality (9th), garnering high marks in measures of patient-centered care and infrastructure.
Portugal’s ranking was hampered by poor scores for Science and Technology (26th) and Choice (25th). Portugal is not a major engine of scientific discovery, and its debt-to-GDP ratio of 128 percent is the third-highest among WIHI countries, only behind Japan and Greece.
Background
The modern Portugal healthcare system was founded in 1979 with the establishment of the Portuguese National Health Service (NHS). While the 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 NHS, but a quarter are enrolled in private insurance, either through a professional association or the individual market. Regarding benefit design, private insurers in Portugal enjoy more regulatory freedom than American insurers.
The NHS directly negotiates drug prices for its enrollees and also uses external reference pricing, benchmarking Portuguese prices to those of other countries.
Quality
Portugal’s health system ranked 9th overall in Quality. In particular, Portugal ranked 13th in patient-centered care, notably higher than its Iberian counterpart Spain, which ranked 19th. Additionally, the country’s medical system ranked 3rd in infrastructure.
Choice
Portugal overall’s ranking was heavily influenced by its Choice ranking, which fell to 25th in 2022 from 11th in 2021. Notably, Portugal’s high cost of health insurance held the country back (31st), even with strong metrics in access to new medical technologies (14th) and patients’ abilities to choose healthcare services (10th).
Science & Technology
Portugal ranked in the bottom tier (26th) of the WIHI analysis in Science and Technology. Notably, its low rate of health digitization (29th) ranked considerably lower than its European counterparts — Spain ranked 15th 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 21st overall. In particular, Portugal’s debt-to-GDP ratio score (29th) affected the country’s overall ranking. Yet, there are still signs of hope. Portugal’s growth in health spending as a share of GDP over the last decade—ranked 6th lowest overall, making it likely that Portugal will improve its overall Fiscal Sustainability ranking over time.
