Sunday 21 March 2010

The health of the Portuguese

According to the previous figure published recently in an interesting overview "Health at a Glance 2009" by OECD, Portugal is not doing so bad in terms of life expectancy, a common proxy for health status, considering the little it spends per capita. The problem is that Portugal is not spending that little, it spends 9.9 % of its GDP as the next figure shows.

Although this report is mainly descriptive, it provides relevant statistics on outcomes of health care (although at points the data from Portugal is either not reported or from previous periods, it is intriguing why it is so). Portugal does well in many important health indicators such as infant and newborn mortality (not in the report). Nonetheless, some of the health outcomes in the report were surprising to me. For example, Portugal is amongst the countries with the highest number of cesarean deliveries (reaching 31% of live births) and the lowest number of nurses per capita (usually an indicator of good quality of health care). More surprising was the following picture regarding the mortality rates after a stroke where the data shows that it doubles that of the OECD. Moreover, there seems to be no recent data on this important outcome.
With this post I do not want to send a negative message about the Portuguese health system, although there is probably room for improvement, instead I would like to call attention for importance on data on outcomes and the need to make this data available for research.


  1. Sera' que gastamos assim tanto em cuidados de saude em Portugal?

    Os numeros que tenho de cabeca, dizem-me que enquanto os EUA gastam 'a volta de $7000 de cuidados de saude per capita, Portugal gasta menos de $1000. Julgo que e' mesmo um dos mais baixos valores para os paises da OECD.

    Claro que este baixo numero esta' mais relacionado com o facto de sermos pobres. Mas dizer que gastamos muito em cuidados de saude, apenas mostrando os 9.9% do GDP reduz bastante a importancia da discussao.

    Como tambem reduz a apresentacao de graficos sobre a esperanca media de vida, apresentando-a como uma proxy para os cuidados de saude. Porque a este nivel nao e'. Portugal tem bons resultados para os indicadores em que a relacao com os cuidados de saude e' mais fraca. Um bom exemplo e' a esperanca de vida que esta' mais relacionada com habitos de vida do que com a qualidade dos servicos medicos - o que explicara' em parte porque e' que temos niveis semelhantes de esperanca de vida com os americanos face 'a discrepancia na despesa.

    Ja' em indicadores mais protegidos de 'elementos externos' - como diagnosticos e mortalidade de certos cancros ou a mortalidade apos um enfarte,- o caminho que ainda temos de percorrer e' longo. E envolvera' mais de crescimento economico do que organizacao dos servicos de saude.

    No entanto mais dados (com limites) sao sempre bem-vindos.

    (e ja' agora uma sugestao ao administrador do blogue - porque nao permitir comentarios anomimos no blogue, na tradicao por exemplo do econjobrumors)

  2. The Portuguese health system has come a long way, but I am not sure if it has grown in height (harmoniously) or if it has grown to "the sides" (not harmoniously). Objective outcomes have improved, but there are still SERIOUS problems in terms of accessibility to healthcare and tremendous social inequalities. Don't forget that around 20% (according to official numbers, but the real figure is probably much higher) of the population lives in poverty or near the poverty line, and the less affluent of society have much worse health outcomes than the more affluent members of society, require much more health care, but ironically they are the ones who receive less health care (Inverse care law, Tudor Hart, 1971, and Gérvas J.] Atención primaria de salud, política sanitaria y exclusión social. En: Políticas y bienes sociales: procesos de vulnerabilidad y exclusión social. Arriba, A. (coordinadora). Madrid: FOESSA; 2009. págs. 359-80.

    Don't forget the best health systems are those that have the best primary care systems, and in Portugal, we still have a long way to go in that regard. Health systems based on solid primary health care have healthier populations, fewer health-related disparities and lower overall costs for health care:

    Competing interests: I am a primary care physician.

  3. First of all let me thank the very valuable comments from Tiago Tavares and Tiago Villanueva from different perspectives. I appologize for the late reply, I was away.
    I completely agree that inequality in health care should be for a National Health Service a priority (if you know of any recent study that measures it, please post the reference). There are some studies for Spain that I know of. I could not agree more with Tiago Tavares, in fact, that was the purpose of my post, to show that while we do well in some common health indicators we do not do so well in others.