Thread by @ATGuerreiro

Thread - Health Care Systems and Bernie Sanders

1- Last Thursday, Senator Bernie Sanders tweeted about "universal health care" systems worldwide listing 28 countries with such systems as examples.

Are such systems worth?

Here's my insight about the Portuguese HCS. 👇

https://twitter.com/SenSanders/status/1227959382387941382

2- The Portuguese HCS is officially known as "Serviço Nacional de Saúde" (SNS)(National Health Service).

According to the Constitution of Portugal, the right to the protection of health shall be fulfilled by "means of a universal and general national health service...👇

3-... which, with particular regard to the economic and social conditions of the citizens who use it, shall tend to be free of charge" [article 64(2)(a)].

In practice, this means that SNS is accessed by any citizen (even by foreigners) regardless of its conditions.

And...👇

4-... each person that makes use of SNS in any public hospital should pay a basic fee ranging between 14€-40€ (maximum fee with all procedures and treatments made).

Medical appointments could cost a maximum of 7€.

And there are exceptions that allow many citizens...👇

5-... to be exempted from basic fees.

SNS is financed by the State Budget and provides health care in all medical specialties.

According to the Health Consumer Powerhouse's "Euro Health Consumer Index 2018", SNS ranks 13th in a group of 35 European...👇

sns.gov.pt/wp-content/upl…

6-... countries.

However, as this study recognizes "real excellence in southern European healthcare seems to be a bit too much dependent on the consumers' ability to afford private healthcare as a supplement to public healthcare".

This is the case in Portugal.👇

7- Our system is already saturated. This is one of the problems of SNS: it demands too many public resources if you want to reach all citizens in a country with an average gross salary of 1.220€ and 650€ of minimum salary and still create exemptions.

Waiting times for...👇

8-... medical appointments can take several months (cfr. dn.pt/portugal/mais-…) or even years (cfr. dn.pt/edicao-do-dia/…).

Waiting times for surgery and/or treatment also take months or years even in patients with cancer (cfr. jn.pt/nacional/aumen…). 👇

9- This happens for two reasons: lack of public resources to feed the systems needs and too many users for what SNS can realistically offer.

Therefore, SNS has no conditions to offer "excellence healthcare" because Portuguese middle class can't afford private healthcare...👇

10-... or a private health insurance covering the same appointments and treatments as SNS. This means we have too many users for the system we have.

As if this weren't enough, this system, because it is financed by the State Budget and is a public system, brings threats...👇

11-... to its own efficiency.

Because it is supervised by the Government, transparency is a problem. Profit isn't a goal. Thus, SNS is more open to celebration of direct agreements and contracts with enterprises regardless of the criteria used. This means, public spending...👇

12-... with different criteria as the one used by the private sector. In some cases, SNS chooses not to spend on staff and equipment but pays more in agreements with the private sector to provide treatments or medical exams.

At the same time, hospital administrations are...👇

13-... oftenly used as a repository of political personalities when their terms end and of nepotism as well. Some recent examples come:
a) former State Secretary for Health: married with Carlos Zorrinho, Socialists strongman, and after only one year in the cabinet...👇

14-... she was appointed President of the main group of public hospitals in Lisbon (cfr. jornaleconomico.sapo.pt/noticias/ex-se…);
b) Mário Pereira, former Member of the Regional Legislative Assembly of Madeira representing CDS party, was appointed...👇

15-... as clinical director of Madeira Region Health service (cfr. publico.pt/2020/02/07/soc…).

Lastly, one should consider SNS as an example of a service that provides an answer to any citizen regardless of its economic or social condition when his private insurance does not...👇

16-... offer a solution or to those who don't have one at all. Still, it demands too many public resources in order to provide an efficient answer to those who really need it.

In the end, Bernie Sanders should disclose his ideia: if he wants a Bismarck or National Health...👇

17... Insurance Model, than Portugal should not be named as an example.

However, if he intends to implement a Beveridge system, than maybe Switzerland and the Netherlands (1st and 2nd best systems in Europe) should not be taken into account.

To name all those 28 isn't fair.🔚