Healthcare in Portugal
The SNS provides universal coverage, although in 2012 measures were implemented to ensure the sustainability of the service by the introduction of user fees to be paid for at the end of treatments.
[1] In addition, about 25% of the population is covered by the health subsystems, 10% by private insurance schemes and another 7% by mutual funds.
It is general as it encompasses the whole range of healthcare, including the health surveillance and promotion, the disease prevention, the diagnosis and treatment of patients and the social and medical rehabilitation.
However, some fees are charged, not in order to finance the system but serving mainly to moderate and filter unnecessary access to the services (e.g. to avoid that a person with a minor injury go to the hospital's emergency department instead of going to a local primary health care unit).
The ACSS is responsible for the central management of the financial, human, equipment and facility resources of the system, as well as for the establishment of health policies, plans, rules and standards.
Despite the Constitutional and other statutory provisions and being referred as "National", the SNS is not really nationwide, as it was never expanded to the Portuguese autonomous regions, only covering Continental Portugal.
The exact status of these regional services and its relation with the SNS is however not clear, as both the Statute of the SNS and the Basic Law of Health are silent about the SRS, with this last one only vaguely mentioning that the health policy in the autonomous regions is defined and executed by the respective bodies of self-government.
Each USI groups all the public healthcare establishments located in the same island in a single administrative unit.
The SESARAM, EPE is similar to a local health unit of the SNS, providing both primary and secondary healthcare.
The health subsystems are the special schemes - parallel to the SNS - responsible for the providing of healthcare to the members of certain professions or organizations.
In the direct scheme the services are provided by medical establishments which have a previous convention with the insurance network.
The SIEM also includes an anti-poison information center (CIAV) and a subsystem for the emergency transportation of high risk newborns to specialized hospital units (TIP).
The ULS group not only the hospitals but also the health centers located in the same city or region, integrating the providing of both primary and secondary healthcare in a single administrative unit.
Most of the public hospital establishments constitute State-owned enterprises (entidades públicas empresariais, EPE).
In terms of service, the SNS hospitals, hospital centers and ULS are either classified as group I, II, III or IV (this being subdivided in the IV-a, IV-b and IV-c groups): Below, is the list of the Portuguese public hospitals establishments, divided by the health regions of the SNS (North, Center, Lisbon and Tagus Valley (LVT), Alentejo and the Algarve), the Autonomous Region of the Azores (SRS of Azores) and the Autonomous Region of Madeira (SRS of Madeira): The social hospitals, are those ones managed by private institutions of social solidarity, namely the traditional Portuguese misericórdias (holy houses of mercy).
Traditionally, the State only kept the direct administration of some public hospitals, located mainly in Lisbon, Coimbra and Oporto.
In 1974, the administration of all central and district hospitals owned by the misericórdias was nationalized and transferred to the State direct management, although not their property.
In order to develop that potential, in 2008, several public and private organizations related with the health sector - including medical services providers, pharmaceutical industrial companies, universities and research and development entities - founded the Health Cluster Portugal (HCP).
