The future for health in portugal—everyone has a role to play

Abstract

—Portugal’s Gulbenkian Foundation set up an independent commission to look forward 25 years to create a new vision for health and health care and make recommendations how that vision could be achieved and sustained. The Commission recognized the wide public support for the health system and the good clinical skills of its health professionals. It noted that Portugal had an aging population, high levels of chronic diseases (particularly diabetes, obesity, and mental health problems), low fertility rates, and high levels of migration. The Commission also noted that Portugal’s health system had wide variability in performance and outcomes, did not use evidence systematically, and duplicated many specialist services. The Commission’s final report proposed a two-part approach of tackling the social determinants of health and seeking to improve health care delivery. It did not treat finance as a separate strategy or variable but as an integral part of both of these approaches. Thus, for example, on sustainability the report concluded that whilst incentives and financial mechanisms could help, the sustainability of the system would be dependent on politicians being willing to introduce health into all policies and action by citizens, wider society and health professionals. This Commission’s report is relevant to other countries that need to address both improving the health of their population and improving health care. In Portugal, a program of activities is underway after publication of the Commission’s report. The Gulbenkian Foundation is promoting these activities by supporting three Gulbenkian Challenges: reducing hospital infections, preventing 50,000 people from getting diabetes in the next five years, and improving child health.