Main Health Issues & Characteristics of Portuguese NHS Amélia Fernandes Valencia, July 2002

1. Main Health Issues & Characteristics of Portuguese NHS Amélia Fernandes Valencia, July 2002

2. Agenda • Evolution of the Portuguese NHS (National Health Service) • Main Portuguese Health Issues & Health Indicators • Methodology and Strategic Approach • Health Programs

3. PORTUGAL • 10.000.000 h (1999) • 90.000 Km2 • 18 Districts (1982) • 5 Administrative Regions (1993 RHAs) + • 2 Autonomous Regions

4. Evolution of the Portuguese NHS, 1971 – 2002 Future? Fonte:Relatório da Primavera dos Sistemas de Saúde (2002) Evolution of the Portuguese NHS, 1971-2002

5. Evolution of the Portuguese NHS, 1971-2002 NHS structure based on the NHS organic law Source: Diario da Republica 1993

6. Fonte:Relatório da Primavera dos Sistemas de Saúde (2002) Evolution of the Portuguese NHS, 1971-2002 The financing of NHS by GDP (1990-2002) (Values * 109 PTE) Source:Annual report form IGIF, 2001 and 2002 NHS and 2002 Rectified budget

7. Fonte:Relatório da Primavera dos Sistemas de Saúde (2002) Evolution of the Portuguese NHS, 1971-2002

8. Fonte:Relatório da Primavera dos Sistemas de Saúde (2002) Main Portuguese Health Issues & Health Indicators Medicines Expenditure (in % total health expenditures) 27,0 25,0 23,0 21,0 19,0 17,0 15,0 13,0 11,0 9,0 1985 1990 1991 1992 1993 1994 1995 1996 1997 1998 França Alemanha Grécia Irlanda Itália Portugal Espanha Reino Unido Fonte: OCDE Health Data 2001

9. Fonte:Relatório da Primavera dos Sistemas de Saúde (2002) Main Portuguese Health Issues & Health Indicators Total Medicines Expenditure ( % GDP) Fonte: OCDE Health Data 1998

10. Fonte:Relatório da Primavera dos Sistemas de Saúde (2002) Main Portuguese Health Issues & Health Indicators Cephalosporins Ambulatory Prescription (% over total) Source: SI - ARSLVT and NHS (England)

11. Fonte:Relatório da Primavera dos Sistemas de Saúde (2002) Main Portuguese Health Issues & Health Indicators Quinolones Ambulatory Prescription (% over total antimicrobians) Source: SI - ARSLVT and NHS (England)

12. Evolution of the Portuguese NHS, 1971-2002

13. Fonte:Relatório da Primavera dos Sistemas de Saúde (2002) Main Portuguese Health Issues & Health Indicators Patients in chronically haemodialysis treatments per provider type PrivatePublic Source: Vinhas, J.

14. Fonte:Relatório da Primavera dos Sistemas de Saúde (2002) Main Portuguese Health Issues & Health Indicators Health Care Consumption % people interviewed that declared having consumption in the last 3 mounths Source: Inquérito Nacional de Saúde, Portugal Continental, 1996, 1997 e 1999

15. Fonte:Relatório da Primavera dos Sistemas de Saúde (2002) Evolution of the Portuguese NHS, 1971-2002 Two Main Critical Defeats of Health Governance

16. Fonte:Relatório da Primavera dos Sistemas de Saúde (2002) Main Portuguese Health Issues & Health Indicators Evolution of the population health status Population health status and utilisation in Portugal, Spain and the UK Source: OCDE, 1998

17. Fonte:Relatório da Primavera dos Sistemas de Saúde (2002) Main Portuguese Health Issues & Health Indicators Mortality Rates (1996-1999) Source: Director-Geral e Alto-Comissário da Saúde, Ganhos em saúde em Portugal, ponto da situação, 2002

18. Fonte:Relatório da Primavera dos Sistemas de Saúde (2002) Main Portuguese Health Issues & Health Indicators Road accidents – Alcoholism rate per vehicle type No alcohol in blood Alcohol in blood Motorcycles Trucks Tourism Source: Direcção Geral de Viação, 1999

19. Fonte:Relatório da Primavera dos Sistemas de Saúde (2002) Main Portuguese Health Issues & Health Indicators Mortality Rate per road accidents and Mortality Rate per AIDS Source: Director-Geral e Alto-Comissário da Saúde, Ganhos em saúde em Portugal, ponto da situação, 2002

20. Fonte:Relatório da Primavera dos Sistemas de Saúde (2002) Main Portuguese Health Issues & Health Indicators Infant Mortality Rate in EU Countries, 1985 - 2000 Source: INE

21. Health Programs Cardioand Cerebrovascular Diseases • 1995 (Barcelona) – 2nd International Conference of the “Healthy Heart”: Catalunha’s Declaration • Objectives: demonstrated that investing in the health of the heart, we can • several complications, inability and live loss;  suffering and incapacity of millions of people;  productivity • 1999 (Portugal – DGS) – “Saúde, um compromisso” • Aims: implementation of the “Coronary Green Way” in 15% of the national hospital net •  less of 20% recurrent CVA in the first two years and guarantee basic functional capacity.

22. Fonte:Relatório da Primavera dos Sistemas de Saúde (2002) Health Programs Amputations in diabetics (/100 000 diabetics) NDP (1974); St. Vincent’s Declaration (Italy, 1989); 300 000 - 500 000 diabetics (3-5%, of which 10-12% are Diabetes Type I) Diabetic foot – hospitalisation; 40-60% amputations for NT causes; 15% Diabetic pop. favourable conditions.; annually: 1300 non traumatic amputations of forelimbs (2001); complications contra lateral limb; 5 years › 50% amputation of CL limb. Source: OPSS Report2002 in M. R. Gallego Investigation Project, 2002

23. 600 000 asthmatics in Portugal “Handbook for Good Practices” “Handbook for help children with asthma”; “Handbook for help adolescents with asthma”; “Handbook for help adults with asthma” Interactive CD 3100 RNEPS integrated schools working in partnership with 600 Primary Healthcare Centres. Health Programs National Asthma Control Program “Asthma schools” Physical Activity Physical Education Teacher’s Handbook

24. Obrigado Thankyou