Chapter nine: Reducing healthcare costs in portugal: Outcomes and implications for public and private medicine

Although the growth of the private sector in health is a global trend, this rise has different meanings and dynamics across countries. In Europe, there is no consensus on the effects of the 2008 economic and financial crisis on health systems, particularly public-private relationships. Between 2011 and 2014, Portugal entered into a financial assistance programme that imposed significant reforms in healthcare. Public expenditure decreased as private funding and delivery grew, and the evidence about short- and long-term effects remains unclear. According to national and international institutions, the National Health Service showed resilience in terms of patients’ access and the quality of care delivered. However, these analyses draw on macro-level and institutional indicators that do not account for those who experienced the changes. This chapter discusses evidence from a national-level survey of physicians regarding how they experienced the crisis in their practice. It provides a broader reflection on the public-private relationship, based on how physicians perceived changes in the delivery of care and the patients’ access to health services. In doing so, the analysis applies insights from sociology. First, it assumes non-linearity between expected and achieved outcomes of policies. Second, it is sensitive to diverse medical areas, to internal stratification in medicine and to the specific traits of healthcare organisations. Third, it assumes that health professionals’ direct contact with patients makes them a valuable source of information that has been largely ignored even in the absence of national-level data that takes into account the reality and needs of specific social groups.