The President of the Republic suggested this Thursday, October 30th, a political agreement on the role of the SNS, the social sector and the private sector in health, so that there is a medium-term framework.
In an intervention at ISCTE – Instituto Universitário de Lisboa, at the end of a conference on the 50 years of the Medical Service in the Periphery (SMP), Marcelo Rebelo de Sousa criticized the constant changes in health policy with successive governments.
According to the head of state, the Government must decide, first, whether or not it wants to make an agreement, but “even without an agreement, it must one day make a decision about this: what should be the SNS, what should be the social sector, what should be the profitable private sector – with enough flexibility to think about interactions.”
“And what in the SNS, in terms of management, should remain public, and what in the SNS, in terms of management, can or cannot be shared with the social sector or the private profitable sector”, he added.
Marcelo Rebelo de Sousa argued that “without defining this with some clarity, it is very difficult to have a framework for political action, political action becomes a case-by-case basis”.
The President of the Republic commented that “it is increasingly difficult” to establish convergences and “cleavages” appear even “in matters as important as, for example, the definition of who is Portuguese, the definition of who who is not Portuguese can live in Portugal, the definition of foreign policy or defense or security policy, the definition of educational policy”.
Referring to the health sector, he lamented: “If the Government ends, another comes in with another health policy. Then another comes in, who has another health policy. There is no health policy that can handle it, there isn’t. Or rather, there is no health care that can handle it.”
“Maybe it’s worth thinking that every time a government changes, it’s not a good idea to also change policy in the area of health,” he advised.
For the head of state, “the issues on which this convergence would be gained” are essentially two: “The vision we have of the national health system” and “the vision we have of the management of the NHS”.
PR considers that “casuistry” prevails and there are “gray lines” in health management
The President of the Republic considered that “casuistry” prevails in health management, with “solutions for the very short term” and “gray lines” between the responsibilities of the Government and the Executive Management of the SNS.
“After six months, a year, a year and a half, it is important to have a general frame of reference, without the exception of there always being emergencies”, stated Marcelo.
According to the head of state, the current panorama “is a dispersion of decisions, it is an erosion of decisions, they are solutions for the very short term or the short term, and then it remains to be defined exactly what the long-term objective is”, which corresponds to the “path of stones, which is the most difficult path”.
PR calls for attention to primary care and raises doubts about recourse to private care at this level
The President of the Republic called for attention to primary health care and raised doubts about the use of private services at this level of the system, considering that for now this is “idealistic, not to say unrealistic”.
Marcelo Rebelo de Sousa left a “final note” on the “specific, unique role” of the National Health Service (SNS).
The head of state defended that the health situation in Portugal “requires that the situation of primary care be taken seriously” and highlighted the importance of the SNS network at this level.
“In primary care, with all its problems, the public NHS network, even when it has deficiencies, as a result of very varied circumstances, has an experience and a tradition that other sectors will have great difficulty responding to immediately. This is not ideological, it is like that, it is reality”, he stated.
According to the President of the Republic, “the idea that basic care can be shared, without problems, like training, with other health sectors, is an idea that is still idealistic today, not to say unrealistic”.
“The ability of other sectors to basically train health professionals in certain specific areas, and with certain responsibilities or complexities, is still very limited, and will be for a while. It’s natural, it’s not to belittle. It takes time”, he pointed out.
Previously, Marcelo Rebelo de Sousa had already referred to the idea of ”associating public and private with primary care, granting concessions, forming partnerships”, and admitted that private companies may not want to “because they don’t have the means for it, they don’t yet have the size for it, they are still at a stage before that”.
The head of state warned that “without the reinforcement of primary care, which is always desirable, and has been attempted in various ways, but without this reinforcement, adapted to the country’s demographic evolution, and mobility in the country, everything will fall on top of other realities of healthcare, particularly hospitals”.
Regarding the SNS, the President of the Republic linked its “specific, unique role” to the Portuguese reality: “It’s because Portugal is an aging country. It’s because Portugal is a country that has between two and two and a half million poor people, it depends on crises, it can go up, it can go down”.
“Portugal is a country that, even with the truly rapid evolution of private health insurance, does not have even half of the population covered by this insurance – not to mention that many of these insurance policies do not charge for the most complex and demanding health care”, he added.
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