In 2024, the National Health Service will be organized into local health units (ULS), bringing hospitals and health centers under a single authority, and regional health boards will disappear.
From January 1, the country will be fully covered by 39 ULSs in a reorganization aimed at facilitating access and movement of people between health centers and hospitals.
ULS should also increase its focus on health promotion and disease prevention.
From January, ULS will be funded according to the clinical risk of the people they serve, a process to progress gradually. The order, published this month, explained that in practice, users are categorized and aggregated based on predictable social media usage needs.
Currently, funding is determined mainly by production, that is, the number of activities carried out.
The tool that will be used combines information on diagnoses, clinical orders, health care utilization, etc., helping to identify population subgroups that have comparable characteristics and have similar health needs.
There will be three subgroups: high clinical risk, consisting of “approximately 5% of Portuguese people suffering from complex diseases”, medium risk, which includes “25% of people living with at least one chronic disease overlapping others” and a third group, which includes “healthy people who do not use social media and those with only acute episodic illness.”
Another change in the SNS organization is the expansion of Family Health Facility (USF) Model B, where health care providers will be paid based on their performance.
In USF’s Model B, professionals receive a base salary and variable pay linked to performance through expanded user rosters, residency, quality access and clinical care.
The government estimates that the move to Model B for all USFs will result in between 250,000 and 300,000 Portuguese becoming family doctors.
Another direction is Complex Responsibility Centers (CRCs) – intermediate management structures within hospitals, created at the suggestion of specialists and with functional autonomy.
Each CRI makes a commitment to the Board of Directors to provide citizens with greater access and better health outcomes by implementing innovative organizational models and evaluating the performance of professionals, including through compensation.
Next year will also see the introduction of a full commitment regime, in line with a work organization model that encourages greater dedication to public service.
In the case of USF and CRI, total dedication is linked to the achievement of goals, and the salary system consists of base compensation, bonuses and performance incentives linked to the encouragement of working in multidisciplinary teams.
Individual doctors will also be allowed to devote themselves entirely to work, while the organization of hospitals in the CRI is not widespread.
In hospitals, CRI specialists can be fully dedicated to their work, as well as doctors who perform service or department management functions, as well as doctors who wish to voluntarily join this regime.
These professionals will have a weekly schedule of 40 hours (35 hours + 5 full time hours). Working five hours entitles you to a bonus equal to 25% of your basic monthly remuneration.
Full dedication will be considered normal operating mode in Model B USF. In all other cases, compliance is voluntary. Physicians who adhere to full dedication are free to practice in private institutions or in the social sector, as long as they guarantee compliance with the 40-hour work week.