Health governance in a context of crisis - the perspective of efficiency and effectiveness in the Portuguese health system

Abstract

The financial and economic crisis from 2008 has
a great impact in welfare states, notably in one
of their fundamental pillars – health. In Portugal,
the total spending on health reached 10.1% of
GDP in 2008 and will increase in view of the
current panorama. The objective of this study is
to analyze the health policies and the Portuguese
health system, in a context of economic, financial
and social crisis, in the light of the speeches of
policy-makers and experts about the processes
of governance and contingency measures,
considering dimensions of analysis efficiency and
effectiveness. In the dimension of effectiveness,
measures have been pointed out for protecting
the most vulnerable, for the empowerment of
citizens, for reduction of inequalities and for the
protection and promotion of health. Finally, in
the dimension of efficiency, there are important
measures to cut off expenditure, of mobilization
of financial resources, in the rationalization of
resources and services and in professional and
organizational development. In theoretical
domains of risk and uncertainty, we see through
the speeches of policy-makers and experts, that
these are domains for the exercise of policies
on critical governance processes, determined
by identified sources of insecurity, processes of
public debate and in terms of policy dispute.