Tag Archive for: private sector

Cesareans prevail in the private sector

The two largest maternity hospitals in Portugal are private. Most babies there are delivered by cesarean section.

Last year a third of all births in the Greater Lisbon area took place in 3 big private hospitals (Lusíadas, Luz, and CUF), where over half of the babies were born by cesarean section. In the 13 public health hospitals of Lisbon, the cesarean rate proved to be much lower (31%), although still higher than recommended by the World Health Organisation (10-15%).

All over the world, there is an increase in cesareans, especially in wealthier environments (highly educated women) for non-medical reasons. The fastest increase occurs in South Asia. In Europe, there are major differences in the cesarean section between member states, where rates vary from 52% in Cyprus to 25% in the UK and 17% in Sweden.

Ten years ago a commission was created in Portugal to reduce the number of cesareans in the country. Although the rate decreased initially, the country continues to rank poorly on this indicator at the international level, basically because of the dominating private sector, where cesarean rates use to be twice as high as in public hospitals.

Portuguese women who can choose to have a child in private hospitals are mainly women with health insurance, which allows them to pay only a small part of the cost of deliveries – which for private individuals can vary from 4000 euros for vaginal delivery to 7000 euros for a cesarean section.

Moreover, the lack of obstetricians in the public sector makes more and more women prefer to give birth in a calm private environment, where most cesareans are scheduled instead of urgent, as in busy public hospitals.

While structural decisions in the ailing National Health Service (SNS) are time after time postponed, the outflow of obstetricians to the private sector continues.

‘Just last week a doctor left the country’s largest public health hospital Santa Maria in Lisbon for the private sector exclusively for financial reasons’, complains Dr. Ayres de Campos, who leads a governmental commission to tackle problems in obstetric care.

‘In the SNS you get very poorly paid and work long hours. Everything that is complicated comes to public hospitals. For years and years, management has been chaotic, there is an absence of thinking in favor of the common good and lots of conflicts of interest’, he sighs.

Enjoy your week                   Aproveite a semana      (pic Público/Sapo)

Lack of doctors, just when reinforcement is needed after Covid19

Despite the fact that Catarina Martins – the leader of the Left Bloc (BE) – regards the National Health Service (SNS) as ‘a pearl of democracy’ and its workers ‘heroes and heroines’, working conditions are poor and staff shortages in public health-threatening. Let’s first take a look at the situation at the doctor level.

More than 1 million users of the SNS do not have a family doctor, most of them living in the region of Lisbon and the Tagus Valley. A situation that hasn’t occurred since 2015.

The Minister of Health – Marta Temido – acknowledges that the number of general practitioners has sharply regressed but justified the shortage by the substantial number of retirements and an increase of 60.000 subscribers to the SNS – due to the demand for vaccinations.

In the first half of this year, more than 230 doctors retired from the SNS – 131 of whom were practitioners in general and family medicine – the minister revealed, whereas last year 653 doctors departed from public health service.

To counter this departure, she wants to open up an extra 400 vacancies for general and family medicine to provide some 650.000 Portuguese with a general practitioner. But whether these vacancies will be filled is the question.

About one-third of all vacancies for newly trained doctors in both hospital and primary care were left open last year. Some doctors preferred to wait for more lucrative positions in the private sector or even abroad, after finishing their internship.

Unfortunately, this has become the trend in recent years. ‘What confuses me is that everyone knows it but doesn’t do anything about it’, states Jorge da Cunha, secretary-general of the Independent Trade Union of Doctors. ‘The SNS isn’t attractive enough to keep young doctors in service as long as there are profitable possibilities in private practice’.

The tragedy is that there are fewer doctors at a time when significant reinforcement is needed to recover what is left undone during the pandemic. In the first year of Covid19, there were 46% fewer physical consultations in primary care, 30% fewer in hospital, and 25% fewer surgeries realized.

The Portuguese League Against Cancer estimates that over 1000 cancer cases (breast, colorectal, cervix) have been missed due to a halt in screening services during the pandemic. ‘The last 1½ year have been spent on counting fatalities from a virus that barely claimed the lives of half the number of people dying from cancer every year’, its spokesman complained.

Stay healthy                                    Fique saudável                     (pic Público)