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

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

Pág. 3 PORTUGAL  h (1999)  Km2  18 Districts (1982)  5 Administrative Regions (1993 RHAs) +  2 Autonomous Regions

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

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

Pág. 6 Evolution of the Portuguese NHS, The financing of NHS by GDP ( ) (Values * 10 9 PTE) Source:Annual report form IGIF, 2001 and 2002 NHS and 2002 Rectified budget Fonte:Relatório da Primavera dos Sistemas de Saúde (2002)

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

Pág. 8 Main Portuguese Health Issues & Health Indicators Medicines Expenditure (in % total health expenditures) Fonte: OCDE Health Data ,0 11,0 13,0 15,0 17,0 19,0 21,0 23,0 25,0 27, FrançaAlemanhaGréciaIrlanda ItáliaPortugalEspanhaReino Unido Fonte:Relatório da Primavera dos Sistemas de Saúde (2002)

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

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

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

Pág. 12 Evolution of the Portuguese NHS,

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

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

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

Pág. 16 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 Fonte:Relatório da Primavera dos Sistemas de Saúde (2002)

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

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

Pág. 19 Main Portuguese Health Issues & Health Indicators Indicator (/ ) Men, till 65 years Women, till 65 years Men, over 65 years Women, over 65 years Mortality Rate per road accidents 31,522,58,25,354,737,618,812,7 Mortality Rate per AIDS 20,217,04,13,73,63,41,10,5 Source: Director-Geral e Alto-Comissário da Saúde, Ganhos em saúde em Portugal, ponto da situação, 2002 Mortality Rate per road accidents and Mortality Rate per AIDS Fonte:Relatório da Primavera dos Sistemas de Saúde (2002)

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

Pág. 21 Health Programs Cardio and 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.

Pág. 22 Health Programs Amputations in diabetics (/ diabetics) NDP (1974); St. Vincent’s Declaration (Italy, 1989); diabetics (3-5%, of which % 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 Report 2002 in M. R. Gallego Investigation Project, 2002 Fonte:Relatório da Primavera dos Sistemas de Saúde (2002)

Pág. 23 Health Programs 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. “Asthma schools” Physical Activity Physical Education Teacher’s Handbook National Asthma Control Program

Pág. 24 Obrigado Thank you