President suggests political agreement about role of health service
Marcelo Rebelo de Sousa argued that "without defining this with some clarity, it is very difficult to have a framework for political action, political action becomes haphazard".
The president of Portugal suggested on Thursday a political agreement on the roles of the health service (SNS), the social sector, and the private sector in health, to establish a medium-term framework.
Speaking at ISCTE – Instituto Universitário de Lisboa, at the end of a conference on the 50th anniversary of the Medical Service in the Periphery, Marcelo Rebelo de Sousa criticised the constant changes in health policy under successive governments.
According to the head of state, the government must first decide whether or not it wants to agree, but “even without an agreement, it must one day decide on this: what should be the SNS, what should be the social sector, what should be the for-profit private sector – with enough flexibility to think about the interactions”.
“And what in the SNS, in terms of management, should remain public, and what in the SNS, in terms of management, can or should not be shared with the social sector or the for-profit private sector,” he added.
Marcelo Rebelo de Sousa argued that “without defining this with some clarity, it is very difficult to have a framework for political action, political action becomes haphazard”.
The president commented that “it is increasingly difficult” to establish convergences and “rifts” appear even in such important matters as, for example, the definition of who is Portuguese, the definition of who cannot live in Portugal if they are not Portuguese, the definition of foreign policy or defence or security policy, the definition of education policy.
Referring to the health sector, he lamented: “If a government ends, another one comes in with a different health policy. Then another one comes in with a different health policy. No health policy can cope; there isn’t one.”
“Perhaps it’s worth thinking that it’s not a good idea to change health policy every time a government changes,” he advised.
For the head of state, “the issues that would benefit from this convergence” are essentially two: “the vision of the national health system” and “the vision of the management of the SNS”.
He also questioned whether, for those with political responsibilities, it’s worth it or not to reach a broader agreement on health policy, adding: “It’s not, it’s not”.
Marcelo Rebelo de Sousa acknowledged that he wanted to “govern without an agreement and then we’ll see, diploma by diploma in parliament” or that he thought “it’s an agreement that the government itself makes with itself and that it will project during the legislature and beyond – it’s an option”.
Whatever the case, he insisted that “a political choice” must be made about the health system, one that answers the following questions: “What do we want for the SNS? On what terms? In what terms, from the point of view of what it manages directly, from the point of view of what it shares or interconnects with other sectors? And what is left for the other sectors?”
For the president, “a non-option on this matter is an option”, which corresponds to “leaving the evolution of events to chance” and then “events will go in the direction of where you bet more you will have more success, where you don’t bet there will be a void that will be filled by others”.