The State Budget proposal for 2026, similar to what has happened in the last decade, increases the allocation for Health again, exceeding 17 billion euros for the first time. However, this budgetary growth raises a fundamental question: how is it possible that, spending more than twice as much today as ten years ago (9 billion in 2015), we face a multiplication of problems that did not exist then?
Anyone who wants to find answers can look at the recent CIP-ISEG/Health, Prevention and Wellbeing Council Study on the evolution of NHS spending over the last decade and the causes of its increase (Study reveals 72% increase in SNS spending in ten years – CIP – Portuguese Business Confederation), where it was spent, what the evolution was, but above all what the results were.
Where is so much money spent? In 2024, expenditure on Human Resources in the SNS will already represent more than 46% of the budget. Analyzing the distribution of expenditure — between human resources, pharmaceutical products, clinical consumables, products sold in community pharmacies and Complementary Diagnostic and Therapeutic Means (MCDT) — we found that the agreed MCDT sector absorbed 12.8% of the expenditure in 2015, a value that dropped to 8.3% in 2024.
This is a notable reduction, contrary to what the media is propagating.
A more detailed analysis of the evolution of expenditure allows us to reach the surprising (but expected conclusion) that the price effect (impact on consumption) was systematically negative. As it is stated there “The price effect is always negative and, in the case of constant prices calculated using the CPI – consumer price index – this effect is so negative that it not only mitigates the quantity effect, but also nullifies it completely, leading to a total negative effect (that is, expenses with complementary diagnostic and therapeutic means carried out by the SNS or by agreed entities observe a decrease, in real terms, from 2015 to 2023).
In other words, the price effect completely nullified the impact of greater demand. Therefore, the sector agreed with the lowest reimbursement value has been producing more and more, because users need it. In simple terms, the State, as a result of exercising its dominant position, systematically failing to comply with legal and contractual obligations to update reimbursement amounts, managed to acquire more rehabilitation sessions, more exams, more analyses, more diagnostic images, etc. for SNS users, always paying less.
Aware of the structural dependence of many small and medium-sized health units, they obtain more services and more treatments for less cost — at the expense of the sustainability and quality of the agreed sector. Just like the English horse, the lack of updating the reimbursement value will end up killing the agreed sector…as has already been seen in obstetric ultrasounds, speech therapy, etc.
Despite the notorious benefits, successive governments prefer to throw money at part of the SNS, instead of ensuring the sustainability of those who, effectively, without strikes or unavailability, deliver value and results quickly and quickly. Citizens must be aware that Conventional Units are an essential pillar of primary care in Portugal and that, unfortunately, they are at risk of collapse.
Why do companies and workers persist in atrophying when they provide value, work, responsibility and results? With a controlled and justified expense? Why is the population being deceived with an alleged privatization of healthcare that has no translation into the numbers? Not even in actions?
Final note: regarding the alleged statements by the executive management of the SNS, let it be clear that the 10% cost reduction can only be due to the inefficiencies of the SNS, halting meaningless, economically unfeasible and irrational internalization processes, when the available capacity of the agreed response, which has already demonstrated to be more efficient, is not exhausted.