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)
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.
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 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.’