Alexandre Morais Nunes

[Hospitals and the Public-Private Combination in the Portuguese Health System].

The Portuguese health system has been characterized by the existence of a constant relationship between public and private sector, both in providing and financing health care. In recent decades, the private sector increased their responsiveness of care, extending the engagement in the relationship with the public sector. This relationship stems from the legal framework set out in the law, developing agreements, conventions and more recently through the model of public-private partnerships. In hospital network, this new dynamic relationship contributed, in the last two decades, to accentuate the mixed characteristics of the system, through a clear strengthening of the private component in the hospital network, particularly by investing in differentiated units.

Doctors, nurses, and the optimal scale size in the Portuguese public hospitals

This study analyses the scale efficiency, optimal scale for hospital clinical staff, and the exogenous dimensions that can be associated with them. They offer useful insights for health policy design, particularly when human resources need to be reallocated across the country due to uneven distributions. Initial data considered a sample of 27 Portuguese general/acute-care public hospitals belonging to the National Health Service, observed between 2013 and 2016. This resulted into a sample of 108 hospitals-year. Data Envelopment Analysis was employed to assess scale efficiency and optimal scale associated with the workforce and at the overall hospital level. Quality and access to health care services adjusted the measures of scale efficiency and optimal size. A multiple regression analysis was carried out to associate optimal scale and scale efficiency to demographics. Optimal scale centred on 274 full-time equivalent (FTE) doctors and 475 FTE nurses. Overall, there is an excess of FTE doctors and FTE nurses, even after potential reallocations. There is an uneven distribution of health workforce, with excess of staff located in urban areas. Hospitals productivity would increase if they reduced their operational scale. Drivers of potential change include population size, childhood mortality rate, birth rate, and purchasing power parity. Health policies are required, not to hire more staff, but rather to promote the reallocation of employees to deprived regions.

Avanços na Política de Saúde Bucal em Portugal

A aposta na saude bucal, apesar de nao ser devidamente valorizada por muitos Governos, e importante para o desenvolvimento da populacao ja que a patologia oral pode ter efeitos nefastos nos mais diversos sistemas orgânicos que asseguram a sobrevivencia dos pacientes. Em Portugal, a promocao da saude bucal nunca foi uma prioridade para os sucessivos Governos. Apenas no ano de 2005 se implementou, no âmbito do Plano Nacional de Saude, o Programa Nacional de Promocao da Saude Oral (PNSO), que dez anos mais tarde, em 2015, sofreu novas alteracoes. O presente artigo realiza uma revisao teorica do desenvolvimento da promocao da saude oral em Portugal, retratando toda a historia da sua criacao, evolucao e perspectivas futuras e cobertura, desde o inicio do Programa ate ao projeto de integracao da Saude Oral no âmbito da atencao primaria a saude.

The health care reform in Portugal: Outcomes from both the New Public Management and the economic crisis

The Portuguese health system concentrates most of its activity in a National Health Service, created in 1979 to promote universal and general access. The National Health Service should ensure equity, efficiency, and quality of all health care delivered services. This study assesses the impact of health care policies between 2002 and 2017, focusing on 3 timeframes: the adoption and adaptation of New Public Management principles to the health care sector (2002 to 2010), the economic and financial crisis period (2011-2015), and the postcrisis recovery period (2016-2017). The current study evaluates the main policy measures in the health sector, presenting their impacts in terms of access, efficiency, accountability, and costs over those 3 economic periods. It was verified that not all the measures implemented by the successive governments obtained the desired outcomes, generating even costs increase, apart from the austerity period in which health expenditure showed a significant reduction because of the financial constraints.

Using Pricing Policies to Promote Public Health: The Sugar Sweetened Beverages Taxation Experience in Portugal

1. Estudante Doutorando em Politicas de Saúde. Department of Surgery and Cancer. Imperial College Medical School. Londres. Reino Unido. 2. Assistente Convidado de Gestão e Liderança em Saúde. Faculdade de Ciências da Saúde. Universidade da Beira Interior. Covilhã. Portugal. 3. Professor Auxiliar Convidado. Unidade Curricular de Políticas de Saúde. Instituto Superior de Ciências Sociais e Políticas. Universidade de Lisboa. Lisboa. Portugal. 4. Investigador. Centro de Administração e Políticas Públicas. Instituto Superior de Ciências Sociais e Políticas. Universidade de Lisboa. Lisboa. Portugal. 5. Associate Professor. Health Economics Department. Imperial College London Business School. Healthcare Management Group. Londres. Reino Unido. 6. Bastonária. Ordem dos Nutricionistas. Lisboa. Portugal. 7. Programme Manager. Nutrition, Physical Activity and Obesity. World Health Organisation. Lisboa. Portugal. 8. Head of the World Health Organisation European Office for Prevention and Control of Noncommunicable Diseases. Moscow. Russian Federation. 9. Secretário de Estado Adjunto e da Saúde. XXI Governo Constitucional. Lisboa. Portugal. 10. Professor Auxiliar Convidado. Faculdade de Medicina. Universidade do Porto. Porto. Portugal.  Autor correspondente: Francisco Goiana-da-Silva. franciscogoianasilva@gmail.com Recebido: 10 de janeiro de 2018 Aceite: 06 de março de 2018 | Copyright