Table 3 Key areas of the Economic Adjustment Programme on the National Health System in Portugal

1 Primary care services

Reinforcement of provision and efficiency of the Primary care services

1.1 Equal allocation of general practitioners throughout the country

1.2 Restructuring of health units into “Agrupamento de Centros de Saúde” and implementing family health units “Unidades de Saúde Familiares”

1.3 Wages and services associated payments

1.4 Introduction of electronic platform of medical records assessed by primary care providers and hospitals

1.5 Increase of the numbers of USFs to achieve an even geographic distribution of GPs

2 Co-payments

Increase in NHS co-payments - user fees, “taxas moderadoras”

2.1 Revision of the NHS cost-sharing schemes (co-payments) to reinforce primary care usage

2.2 Automatic indexation to Inflation of co-payment taxes

3 Hospital Care services

Centralization and Reorganization of public hospitals to attain savings in operational costs

3.1 Merging of numerous hospital outpatient services into primary care units

3.2 Staff reallocation

3.3 Rationalization of resources and facilities

3.4 Decrease in staff overtime compensation

4 Pharmaceuticals

Reduction in public spending

4.1 Revision of pricing systems, price reduction in expenditure for Pharmaceuticals

4.2 Reduction in the regulated price increase rates for pharmacies

4.3 Reinforcement in compulsory prescription of generic medicine

4.4 Formation of intensive monitoring mechanisms with evaluation and response to physicians

4.5 Introduction of clinical guidelines

4.6 Compulsory electronic-prescription for consistent monitoring evaluation and reporting

5 NHS (General)

Healthcare cost reduction

5.1 Fundamental revision and adjustment of accompanying exemption rules for healthcare payment

5.2 Reduction in tax allowances for healthcare expenditure by two thirds, including private insurance expenses

5.3 Revision in provision and purchasing procedures to accomplish savings by centralizing procurement (i.e., reduction in transaction costs)

5.4 Cuts in non-emergency transportation to healthcare facilities