The reform of the NHS in Portugal

Abstract

The objective of this article is to describe the Portuguese National Healthcare Service, giving a special emphasis to the recent reforms that have been introduced since the beginning of 2002. Its main argument is that there are two different (but connected) rationales that underpin the orientation of the current reforms. One the one hand, the explicit rationale that refers mainly to the ‘visible’ and stated causes and motivations of the reforms. On the other hand, the implicit rationale, whose influence over the government’s actions is not expressed as such, either because it is not perceived, or because it is not assumed. For this purpose, it is essential to start by giving an historical account of how the NHS started in Portugal and in which direction it has been evolving in the last four decades. This section has particular interest considering that it gives meaning, together with other arguments, to the implicit rationale, to the extent that the current reforms are product of the historical context in which the NHS was created and its subsequent developments. In the second part, the focus is on the reformation period, that started in 2002 and that is still going on at the moment. The main reforms that are being conducted are analysed, being this section mainly of a descriptive nature. What is considered to be important in this section is to give the government’s account of the reforms, in order to make clear what are its motivations and its goals. Furthermore, by doing this analysis it makes it possible to put forward what is meant by explicit rationale and identify its features. In section three, the reforms described in section two are analysed individually in a critical way. The objective of this section is to ‘make sense’ of the reforms being undertaken by the government and consider some aspects that are still unclear and that need further reflection. It is throughout this section that the main argument of this article is explored, by discussing, when applicable, what is the rationale underpinning the different reforms