Public expenditure with health in Portugal

Abstract

This article analysis the evolution in the public expenditure on health in the period 1970-78 classified in four major areas - in-patients personal care, out-patients personal care, non personal care and adminstration, training and research - and for the three major health sub-systems, the C.G.E. sub-system (State General Accountes), the S.M.S. sub-system (Medico-Social Services) and the A.D.S.E. sub-system (Civil Servants Health Services). From the four working hypothesis put forward, two were widely confirmed, one had no confirmation at all and the fourth would need further analysis to anlow more definite conclusions. Thus: - The health sub-systems of larger overall volume, either in expenditure or in the population involved would tend to grow more rapidly than those of smaller volume, whatever their financing means. This hypothesis was confirmed, taking in account de 1972 year-base (100) the smaller sub-system - A.D.S.E. (about 4% of the public sector expenditure in 1978) - grew up 128 points, the S.G.E. 242 points and S.M.S. only 66 points, the last one due to exemptions of payment of hospital bills. - In a fee-for-service health system, costs would tend to be higher than in a salaried basis system. This hypothesis was widely confirmed. In fact, the average cost for consultation (including medicine and paramedical services) in S.M.S., in 1978, was about 462$00 against 701$00 in A.D.S.E. Taking into account the non-reimbursable expenditure which is supported by the users, the difference is even more noticeable: the average cost is then 589$00 in S. M. S. and 1066$00 in A.D.S.E. - The centrally financed systems or, at least, the centrally coordinated ones would tend to control the growth of expenditure more efficiently and increase the overall efficiency of the system more than systems with various financing sources. This hypothesis lacks further analysis due to the fact that data was only available for one year after the centralizing action had started. - Expenditure on staff not only absorb the largest share from all the items considered but also have a tendency to be the item with the largest rate of growth. This hypothesis was largely confirmed, considering that this expenditure amounted to 78% of total expenditure in 1978, in relation to 52% in 1970.