Tag Archive for: SNS

Healthservice

Health Services disease: easy diagnosis, difficult treatment

Is the National Health Service still sustainable?
60% of private deliveries are by Caesarean section, twice as many as in the SNS.
43 public hospitals on the brink of collapse.
More than two thousand family doctors are out of the SNS.
Health Centres lack almost everything.
Public hospitals suffer from ‘persistent underfunding.’

Centre-right government doesn’t want doctors to be hired by private agencies.
More than half of SNS doctors also work in the private sector.
The vast majority of foreign doctors are working in the private sector.
Private hospitals break records with over 10 million consultations per year.

Mother loses baby after visiting five hospitals.
Infant mortality increasing in Portugal.
Infant mortality peaking since 2019. Unguarded pregnancies may explain.
Why do SNS professionals run away?

2,700 doctors leave Portugal for abroad.
In Portugal most people die in hospital, relatively few at home.
Portuguese medical specialists are among the lowest paid in Europe.
Health workers are depressed.

Number of nursing graduates below the EU average.
Order of Nurses warns of the ‘escape’ of nursing professionals from Portugal.
No progress in nursing careers.
Almost 1 million waiting for hospital appointments.
Over 7500 victims of cancer await critical surgeries.

Diagnosing the evils of the SNS (National Health Service) in Portugal is easy because the holes are in plain sight. The SNS used to be outstanding when created almost fifty years ago. Although it still maintains some excellent services, it has been degrading for not having adapted to a different society, states professor António Sarmento in the newspaper Expresso.

The price of health care has increased exponentially as a result of medical progress with technical and pharmacological innovations, many of which without a clearly demonstrated cost-benefit advantage.

There is an increasing stimulus to consumption in health care whose main focus is profit, as if health were a commercial activity. To enhance this demand for health care are the exaggerated expectations in the possibilities of Medicine.

It is unacceptable that private clinics try to condition the salary of doctors to the number of tests requested. There are even clinics announcing the offer of free radiographs as a gift for procedures performed.  

But are public hospitals a paradise of ethics and virtue? Of course not. It is enough to look carefully at the perversion of some programs of the so-called additional production in some hospitals or at the administrative pressure that threatens good medical practice and demotivates the professionals.

What will be the solution? There seems to be only one way: a structural reform of the SNS, facing it as an imperative of national interest. There are general principles underlying any global reform of the health system

Health cannot be a business case like selling cars, apartments or commodities. Its merely commercial essence cannot be accepted, reducing health to a consumer good and the patient to a customer

There is only one Medicine: the one centred on people!

Promotion of health literacy should be based on Science, including universal concepts of dignity, compassion and beneficence, not forgetting respect of those who take care of others.

Cooperation with Public Health Services of the EU member states is warranted for the solution of problems that are common to all.

It is high time the country finds financing mechanisms that allow sustainable, accessible and equitable health for all.

Enjoy your week          Aproveite a sua semana               (Pic Público/PtRes)







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Cesarean

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)











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Shortage-nurses

‘Just clapping doesn’t solve anything’

Despite the fact that Catarina Martins – the leader of the Left Bloc (BE) – regards the National Health Service (SNS) ‘a pearl of democracy’ and its workers ‘heroes and heroines’, working conditions are poor and staff shortages in public health threatening.

After having reviewed the shortage of doctors in the SNS, let’s now take a look at the field of nursing.

When Portugal froze nurses’ career progression and salaries during the financial crisis some ten years ago, thousands went abroad in seek of greener pastures. There are currently 20.000 Portuguese nurses working elsewhere – mainly in the UK, France, Spain, and Germany – where salaries are easily 3 times higher.

In Portugal, the ratio of nurses/inhabitants is low (6.9/1000), compared to EU countries (9.3/1000). The Independent Union of Nurses recently highlighted the lack of appreciation of the nurses by the Government, leading to another 1300 professionals leaving the country during the Covid19 pandemic.

According to the Nurses Association (OE), there are approximately 45.500 nurses working in the SNS.
‘A general nurse earns 1200 euros per month at the start of her career and will only be evaluated for upgrading every ten years’, says Guadalupe Simões, head of the Portuguese Nursing Syndicate. ‘After tax, some take home as little as 980 euros, just 315 above the minimum wage. Many have two jobs to make ends meet. Even those who have worked a lifetime can only hope to reach a salary of 1800 euros at the end of 40 years’.

The OE foresees further mass emigrations of nurses after an exhausting and unrewarded fight against the pandemic. ‘The Government must adopt policies to keep nurses in the country and that is impossible with low wages’, the outspoken president of the Association – Ana Rita Cavaco – declared. To back their demands a general strike will be called on November 3rd and 4th.

In order to recover the level of primary care damaged by the epidemic and in view of the EU Recovery Plan – aiming to rebuild a more resilient post-Covid19 Europe – the OE proposes the assignment of a family nurse to each family/patient.

‘There are currently 3000 nurses involved in the coronavirus vaccination campaign, which could be considered for this purpose. Family nurses can play a decisive role in the recovery and consolidation of people with chronic illnesses and dependents at home, who are now in a situation of greater vulnerability.’


Enjoy your weekend      Bom fim de semana      (pic Público/Sapo)








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Waiting

The most common chronic disease in Portugal is called ‘waiting list’

Patients have to wait 3 years to see a urologist in Vila Real or an ENT specialist in Leiria and 2 years to obtain an appointment with a cardiologist in Guarda. These extremes not only occur in the countryside, as the waiting list for a neurological consultation at Amadora Sintra – one of the biggest state hospitals in the country – exceeds more than a year.

Is it a wonder, that citizens – especially the ones who can afford it – turn to the private sector, where waiting periods – due to more specialists – are half as long as in the National Health Service (SNS).

The average waiting period for (non-acute) specialist care in Portugal is 4 months, varying from 6 months for an ophthalmologist to 6 weeks for an obstetrician. Patients who have to wait for more than five months have – by law – the right to be treated in the private sector. A costly buffer as the SNS, respectively the taxpayer must pay the bill.

‘The SNS is overstretched, needs more specialists, family doctors and in particular more funding. Specialists are overworked and underpaid, 750.000 citizens still have no family doctor and the government spends less on ‘health’ than the average EU member state’, says Miguel Guimarães, president of the Medical Association. ‘Last year we received a red cart from the Euro Health Consumer Index for our poor accessibility to (non-acute) specialist care and the yellow card for our lack of general practitioners.’

The excessive waiting lists are – according to the independent trade union of doctors Sindicato Independente dos Médicos – mainly the result of the fact that specialists in state hospitals have to spend too much – almost half – of their time to emergencies. The majority of the specialists working in the SNS is therefore unsatisfied. Many want to abandon the service and either go into private practice or leave the country, where working conditions are better and the pay higher.

‘Wages are indeed low, excess hours abundant and career prospects nil’, explains Maria Ferreira of the Public Health Department of the University of Porto, who conducted an investigation under 15.000 doctors in northern Portugal. ‘Half of the recently qualified doctors is thinking of leaving the country after finishing their specialization and over 1200 doctors have already left in the past 3 years.’

Although the right to healthcare is enshrined in the constitution, lack of accessibility affects poor people most as the private sector is no alternative to them. The only they can do is hope for the best and wait.

Bom fim de semana               Have a great weekend                (photo’s Público)

 

 

 

 

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