Interview: Adalberto Campos Fernandes – Minister of Health, Portugal

Portugal’s Minister of Health, Adalberto Campos Fernandes, details his three-tiered plan for national health in Portugal. He explains that empowering citizens, transforming the sector digitally and ensuring that the proximity of care is readily available to the entire nation are vital elements to combatting pressing problems concerning debt, an aging population, and risks of modern lifestyles.

What are the significant reforms you have implemented and how have they changed the face of healthcare in Portugal?

“Between 2016 and 2017 Portugal approved more than 120 innovative drugs in areas including oncology, HIV, and rare diseases”

From 2011 to 2013 we benefited from international and external assistance from financial programs to assist the economy’s regrowth. Portugal had suffered a lot due to external and internal constraints, and following this challenging time, our foremost goal was to recover, to stabilize the economy and rebalance financial accounts. I am delighted to announce that this is now a reality in Portugal. We are performing favorably; we see remarkable GDP growth, low rates of unemployment and enjoy a more stable budget.

We can now turn our gaze towards refining social cohesion and implementing reforms which will directly impact equality. To this end, by improving accessibility to the system and ensuring that all people have the same high-quality access to healthcare, we will reduce the gap between well-off and less economically advantaged residents. This equality dilemma is prevalent in Europe whereby less financially developed areas cannot access the same level of healthcare available in wealthier areas.

The primary objective is to ensure there are no economic barriers to success and to improve the levels of performance across the entire system. We want to build on the level of activity, the number of surgeries, surgeons, constellations, and coverage provided by family doctors. Since 2015, we have integrated more than 7,000 professionals, comprising doctors, nurses and other healthcare professionals. Policies target primary care services, where we see more family doctors and family care units, and to improve the performance of hospitals especially in reinforcing long-term healthcare assistance. We now have more beds in long-term facilities for example, but we have a lot of work to do in the face of future problems.

What projects do you have in the pipeline for 2018?

This year we would like to reinforce our human resources network while bringing into focus the digital transformation of the healthcare system. 21st March marks the eHealth summit in Lisbon, which will be an intriguing demonstration of modernization and digitization. Off the back of these changes, we will speak with the President of Infarmed, the Portuguese Medicines Agency, to improve access to innovative medicines.

These steps forward contrast sharply with the difficult period between 2011-2014, and we now have the resources to adopt new techniques and new medicines. For example, between 2016 and 2017 we approved more than 120 innovative drugs in areas including oncology, HIV, and rare diseases. The mainstream of our reform showcases our ambition for public health in lifestyles: fighting sugar, salt, and diets high in fat, as well as harmful foods. We are also working hard to raise awareness of other lifestyle risks such as tobacco and alcohol.

The National Health Plan accurately lays out our intention to promote health through disease prevention and consists of three pillars: the new ambition of public health, healthcare’s digital transformation and the literacy and empowerment of citizens regarding their health status.

As part of this program, we will increase investment into public health which was historically as little as two percent. We will prioritize dentists, ancillary tests and other professions including rehabilitation assistance. These improvements represent a new approach concerning the empowerment of people and their ways of life and their attitude towards healthcare.

What are the challenges you face as Minister of Health?

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As with most countries across Europe, Portugal has a hurdle to overcome in its demographic transition; we have fewer births than deaths, and the vital index is less favorable. Portugal is one of the oldest aged countries in Europe, and in the next five to ten years we will encounter more problems associated with an aging population. The challenge is not only regarding financing retirement payments for retirees but also concerning preparing the healthcare system to deal with octogenarians who may spend their remaining years in and out of the hospital.

The threat of diabetes in Portugal is high on the agenda. At 12 percent we have one of the highest prevalences in Europe. We must have a strategy targeting diabetes and to show people how and what to eat, to avoid the over-consumption of sugar. We made exceptional progress in this area with our sugar tax on fizzy drinks last year, as recent figures show that as much as five percent of harmful beverages sales decreased. If we carefully consider the nature of the problems today, we can prepare for issues of tomorrow.

Apipharma’s recent report showed that public hospitals across Portugal are in over 951 million Euros worth of debt. What steps are you taking to tackle the public debt issue in Portugal?

There has been a slight delay in getting to the bottom of the debt issue, but we are now working closely with the Finance Minister to inject the entirety of the 1.4 billion that we planned in late 2017 into the public sector. 400 million euros has already been transferred, and we anticipate another 500 million by the End of March.

Financing conditions are currently not in line with innovation strategies which inevitably causes debt to rise. We aim to stop this harmful cycle and to develop a structure that will align Portugal with the European directives of payments to our providers. We are confident that until the end of this legislative session next year, we will experience the best debt management performance that Portugal has ever had, impacting the healthcare and pharmaceutical industry.

Recently, we allocated 20 million euros over a three-year period—a considerable sum of money—to an innovative agency devoted to investigations into clinical and biomedical fields. The Biomedical Agency, coming to Porto very soon, is backed by public funds and includes the cooperation of the Portuguese Association for the Pharmaceutical Industry and the Portuguese Health Cluster. The effort will reinforce clinical and biomedical investigations across the nation.

The objective of the Minister of Health and the Minister of Finance is to ensure that by October 2019, we have the best performance regarding debt, and we will stabilize this chronic problem that presents complex explanations.

How would you describe the relationship between government and pharmaceutical companies?

On the whole, we have an excellent strategic relationship with pharmaceutical companies, although one of the talking points is reparations. This week I hope to sign an agreement for 2018 with the Ministry of Finance and Economy concerning new, exciting and innovative drugs that we submitted to Infarmed. In addition, we have new projects that will impact chronic diseases including HIV; and are now going to develop the delivery of preventative drugs. In HIV, we are European market leaders for these pain management drugs.

We have a good understanding of pharmaceutical companies, despite our differing motivations. As a government, we have to serve the people in the global context while balancing the budget, all the while fully aware of our market size and population. We are obliged to balance the needs of the country; we have transport, education and science sectors that are all important. Nonetheless, we enjoy good dialogue with pharmaceutical companies, they are cooperative, and both parties strive to reach innovative solutions to shared needs.

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Pharmaceutical companies want to sell the best and most helpful drugs they have, and we in government want our citizens to have access to the best innovations available. We face similar concerns across Europe regarding the limitation of resources, but the desire to provide the best healthcare possible is present and encourages good dialogue between both parties.

What is the importance of the e-Health summit for Portugal?

At this summit, there will be 10,000 people present, and it is one of the most prominent e-Health summits in Europe. We have a large number of international visitors who attend not only for better understanding of classical applications of clinical software, including prescriptions and X-Rays, but health start-ups that invent and discover every day.

The world has dramatically changed for the better in recent years, and we are now living in an age where digitization, Big Data, the democratization of information and instant access offers enormous opportunities in healthcare, whether it be in patient safety, scientific activity or in innovation. We have more commitment to citizens and more choice available at their fingertips.

We see these changes manifest in healthcare in e-prescriptions, where the receipt is no longer in a paper form but online. We look to the digital transformation as an essential opportunity to accelerate reform and transformation movements. The health system is closer to people if you reduce bureaucracy and eliminate paper, simplifying procedures. Further, if we can put doctors, healthcare professionals and patients in a continuous dialogue thanks to technology, then we can clarify things for the future.

Do you have a final message for our international readers?

I am a huge advocate for digital transformation and the positive impact it can bring to healthcare. The key to a successful healthcare evolution is to transform all of these progressions in science into common language. We must fight against the darkness of ignorance and anti-culture by ensuring that people are well informed of changes in healthcare to ensure a healthier Portugal.

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