Portugal: #21 in the 2020 World Index of Healthcare Innovation
Portugal’s partly private system boasts excellent quality, but struggles to find a sustainable fiscal footing.
By Gregg Girvan, Mark Dornauer, and Avik Roy
Introduction
Portugal ranks 21st in the World Index of Healthcare Innovation, with an overall score of 44.82. The Iberian nation is a top-tier performer in Quality (#3, 69.22), garnering high marks for patient-centered care and health outcomes.
Portugal’s ranking was hampered by poor scores for Science & Technology (#25, 27.01) and Fiscal Sustainability (#27, 42.88). Portugal is not a major engine of scientific discovery, and its 128% 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 2nd in patient-centered customer service — notably higher than its Iberian Peninsula counterpart (i.e., Spain ranked 26th). Additionally, the country’s medical infrastructure ranked in the top third of all countries examined (11th).
Choice
Portugal ranked 15th for overall patient choice. Notably, its high cost of health insurance held the country back (21 of 31), even with strong metrics in access to new medical technologies (15th) and patients’ abilities to choose health care services (10th).
Science & Technology
Portugal ranked in the bottom-third (25th) of the WIHI analysis in science and technology. Notably, its low rate of EHR adoption (26 of 31) ranked considerably lower than its European counterparts (for instance, Spain ranked 14th in this category). Additionally, Portugal’s contributions to medical innovation (17th) and scientific innovation (24th) were lower than expected.
Fiscal Sustainability
Portugal’s fiscal sustainability ranked 24th 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 overall — showing a shift toward financial austerity to offset its debt dilemmas.
