Context
In September 2019, the Portuguese Parliament passed a new Health Basic Law, derogating the 1990 Health Basic Law. The new Law has been approved with the votes of the ruling party (Socialist Party) and left wing parties, while right wing parties voted against it, after intense debate both in the parliament and in the society.
The previous 1990 Health Basic Law established the framework for the Portuguese health system, where the National Health Service (NHS) was given the same importance than the private and social sector providers. This Law foresaw support for the development of the private health sector in competition with the public sector, incentives for the creation of private units, and support for facilitating the mobility of health professionals between the public and private sector.
Rationale for the reform
The debate on a new Health Basic Law was introduced by left wing parties, aiming for the total separation of public and private sectors and, particularly, for the exclusion of clinical management in public-private partnerships in the NHS. In contrast with the 1990 Law, the new Law should clearly state that the NHS must be publicly managed, excluding any private management of public facilities.
Content of the reform
The new 2019 Health Basic Law highlights the central role of the NHS, including the public management of NHS units, mentioning that the State responsibility is primarily the NHS, although contracts with private and social sector entities can exist, but only in a supplementary and temporary basis, in case of need. The legislation establishing the NHS’ management framework needs to be done within the 180 days after the Health Basic Law has been enacted.
The second most important aspect of the new Law is the exemption from user charges on primary care and other health care prescribed within the NHS.
Being a framing law, further legislation is required to be passed in a later stage for the 2019 Health Basic Law implementation. The Health Basic Law will have a series of legislation to be approved on particular issues. The most important is the NHS’ management framework, while the regulation of user charges was already published (Law No. 84/2019, of 3 September 2019), and it will be effective from the next State Budget. The Parliament is supposed to oversee the implementation of the new Health Basic Law.