Tag Archive for: SNS

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)

‘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)

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)