Sixty years of reform in the Portuguese health system

The authors review 60 years of health care reform in Portugal. The major reforms emerged after the 1974 revolution. The initial period, up to the 1ate 1980s, was a period of development of a very centralised national health service. From the 1990s onwards, concerns with decentralisation were reflected in a number of initiatives: the emergence of regional health authorities; internal health markets and contracting agencies; the purchaser-provider split; entrepreneurial management experiences; local services; vertical (local) integration; and regionalised networks of facilities. These efforts have ensured that health policy, including fiscal matters, remains centrally controlled, while service delivery has increasingly undergone decentralisation, mostly of two types: devolution and deconcentration. Privatisation has also experimented with but has led to recentralisation. Therefore, in Portugal, the search for a decentralised model has involved an ongoing re-balancing of national and sub-national decisionmaking roles. It is not expected that Portugal will see a major decentralisation drive in the near future

Business · Decentralization · Devolution (biology) · Economic growth · Economics · Environmental health · Health care · Health services · Market economy · Political science · Population · Portuguese · Service (business) · Service delivery framework · Global Health Care Issues · Healthcare Systems and Practices · Healthcare Systems and Reforms · Medicine · Public Administration