LISBON -- Free state-funded health care is one aspect of the post-WWII political settlement of which Europeans are most proud. But now it could be under threat as governments are strapped for cash, and in Portugal, one of the continent’s poorest performers, the question of whether free health provision is still affordable is pressing.
Portuguese citizens have their vices like anyone else. But if their health deteriorates, they know, like most Europeans, there is a high quality yet mainly free health care system to look after them.
But big spending cuts were a condition of the country’s recent bailout, and hospitals are cutting salaries and getting rid of staff.
In short, people have to pay more to see the doctor.
Antonio Arnaut, former Minister of Social Affairs, helped set up Portugal’s health service after the fall of the dictatorship in the 1970’s. Now a lawyer in Coimbra, north of Lisbon, he’s angry at the cuts.
"I'm worried about the future of the National Health System, but not because of the economic difficulties that Portugal is now experiencing, my main concerns are about this right wing government," he said. "There’s an ideological project to destroy the National Health System. The National Health System is a part of the European social model."
Regardless of costs, the Portuguese have benefited greatly from Arnaut’s creation. Forty years ago, 1-in-20 Portuguese children didn’t survive infancy, and now it’s only 1-in-300, and general life expectancy has increased by 12 years over the same period. But the specter of massive government-spending cuts has thrown this success story in question: What happens when a billion euros get slashed from a 7.5 billion euro health budget?
Professor Pedro Barros at Nova business school in Lisbon isn’t overly pessimistic. Two-thirds of the savings, he said, will be achieved by reducing drug prices and cutting staff wages, limiting the impact on services. Significant change, he said, will come in other forms.
"I think that people want a health service the way it is: Funded by government and mostly free at the point of use," he said. "The discussion is on how people provide healthcare, whether it is going to be the private parties to provide it, including the non-profits."
Not only have private health care providers already started running hospitals on behalf of the Portuguese government, the country has a thriving private health sector.
The Malo Clinic in Lisbon is one the world's largest center in implantology and dental aesthetics. Dental care is not covered by the state, and the clinic's boss, Paolo Malo, said Portugal's financial difficulties mean more people should pay.
“We should not have universal healthcare that gives care to anybody that comes to a public hospital. Only the people in need or below a certain income should benefit from this," he said. "That change will happen. It’s not a question of if you like it or not like it -- that will happen.”
Malo may have expanded his business all over the world, but Portugal’s overall economy is in its worst recession since the 1970’s.
If the country has to continue cutting government spending for years to come, perhaps a system almost all of the country still holds dear will have to be slimmed down.