Looking at my country’s national health service which is chiefly funded by taxes, from a user’s rather than from a provider’s perspective (or better, from a passive rather than from an active perspective), gives me plenty of food for thought.
A relative of mine was recently admitted to the local hospital in very serious condition. They had not been feeling well for a couple of days, and I decided to check up on them before leaving for a conference in the north of Portugal, where I was due to chair a session the following morning.
When I got to their house, they were extremely unwell. The differential diagnosis was broad, but given that I was familiar with their medical history of multiple co-morbidities, all the diagnostic possibilities in my mind pointed to life threatening conditions. I decided to immediately call 112, the European emergency number, and an ambulance belonging to the Portuguese Medical Emergency Network with two emergency technicians was at the doorstep in under ten minutes. When I was in medical school, a person like my relative would represent the typical patient of internal medicine rotations: elderly, dependent, and with multiple medical co-morbidities. On that day, I was not seeing a patient in front of me, I was seeing my relative. My immediate concerns were not to sort out exactly what were and what to do to counter the potential multi-organ malfunctions, but rather to hope they would recover and that they would not suffer. Medical training makes us pretty proficient and resilient to deal with our patient’s suffering, but it doesn’t prepare us to deal with the suffering of our own loved ones.
Upon arriving in the emergency department, the medical team on-call managed to stabilise them, and they were transferred to a ward roughly 24 hours later. Moreover, the skilled multidisciplinary human resources and technological infra-structure required to deal with highly complex acute cases such as my relative incur great financial costs. It’s not unusual for us healthcare professionals to rant about our working conditions and remuneration, but on that day, I was the most grateful citizen in the world. I don’t think the care provided to my relative differed significantly from the care that is available in the most developed countries in the world. I feel they received everything they were entitled to in terms of diagnostic and treatment resources, and in accordance to current modern standards of care and the best practices around the world. And all this comes at no financial cost for the family. Despite the clouds of the financial crisis that seem to have come to stay in Portugal, the existence of our national health service enabled my relative to receive sound pre-hospital emergency, hospital emergency, and post-acute medical care. A very large part of the world’s population does not currently have access to this sort of comprehensive, nearly “free,” health care. And with the state budget for health tightening up this year in Portugal, I become concerned every time I hear reports in the news like the shortage of certain drugs in a certain hospital or how Portugal’s largest maternity hospital in Lisbon has now started asking for donations (when Portugal had no tradition up until now of philantropy in the health care field).
Portugal’s national health system has come a long way, and has made Portugal one of the best countries in the world to be born nowadays. In 1960, its infant mortality was rate was 77,5 per 1000 live births, comparable in the present day to that of many Sub-Saharan African nations. In 2009, its infant mortality rate was 3,6 per 1000 live births, one of the lowest in the world. It would be a shame to see this fall back due to the current climate of financial austerity, which hampers the less priviliged but not the wealthy.
Tiago Villanueva is a newly qualified General Practitioner based in Portugal and former BMJ clegg scholar and editor, studentBMJ