Tiago Villanueva: Austerity eroding Portuguese healthcare

Tiago_VillanuevaIn 1960, Portugal’s infant mortality rate was 77.5 deaths per 1000 live births, which is comparable to that of many Sub Saharan African countries today. In 2010, Portugal’s infant mortality rate was 2.5 deaths per 1000 live births, one of the lowest in Europe and in the world.

These achievements in maternal and neonatal health constitute one of the most spectacular triumphs of Portuguese medicine. I was thus somewhat shocked when the Government announced that it will close down Portugal’s biggest and best maternity hospital, Alfredo da Costa Maternity Hospital, in Lisbon, which I mentioned in the BMJ some years ago.

Its excellent reputation rests on the know-how of multidisciplinary teams of obstetricians and nurses who work together with technicians and doctors of other specialties. This makes it possible to predict complications in complex cases and tackle them in a timely fashion. The government says that the Greater Lisbon area, which has around two million inhabitants, has nine maternity hospitals with an overall ability to deliver 28 000 babies per year, despite the fact that the current number of deliveries per year stands at around 21 000. Furthermore, the government has added that the hospital lacks the means to deal with delivery complications, even though Ana Campos, the hospital director, has mentioned in a recent interview to a Portuguese weekly, that the only thing the hospital is not able to handle is cases of maternal cardiac disease, and there are very few cases of this per year.

Another argument that the government has pointed out in favour of closing the maternity hospital  is the poor condition of the building. Dr Campos stated in the interview that 11 million euros in renovation and equipment upgrade have been invested in the hospital since 2004, and stressed that the neonatology department is the best in the country, and that millions of euros have been pumped into the assisted reproduction unit.

Trimming down wasteful hospital capacity apparently makes sense in times of austerity, but surely not at the cost of the jewel in the crown. There are two other maternity hospitals in Lisbon, which deliver babies at a rate considerably below their capacity. One of them has received millions of euros in investments, but is located in a wealthy district where people are either less likely to resort to public hospitals, or are too aged to have children. Furthermore, a new public hospital in the Greater Lisbon Area with the capacity to deliver babies has just opened its doors a few months ago. This does not make sense if the government argues that demand is lower than the supply. It is perhaps relevant that this new public hospital is run by a private bank through a public-private partnership.

Dr Campos added that not only is the government bowing to the interests of private companies, but that its real agenda is to have access to the valuable real estate where Lisbon’s main maternity hospital currently stands.

But the government has argued that the opening of this new hospital has led to decreased demand in several hospitals in the Lisbon area, particularly Santa Maria University Hospital, the largest hospital in the country, which is another reason justifying the closure.

I would like to believe that the harsh austerity measures being implemented in the healthcare sector will, in the long run, improve many bad things in Portugal’s national health service. But I am sceptical that also taking out the remaining good things will help save money in the end.

Perhaps not surprisingly, according to the latest polls, over 40% of Portuguese people rate the work of the current health minister, Paulo Macedo, as “very bad.” Furthemore merely one fifth of Portuguese people are familiar with the name of the current health minister, and only 15% can recall it accurately, according to the polls. Even worse, in the same polls, nearly 50%of Portuguese people consider the government’s communication skills with the general public as either “bad” or “very bad.” I rest my case.

Tiago Villanueva is a locum GP based in Portugal, and a former BMJ Clegg Scholar and student editor, studentBMJ. He can be followed on Twitter at @tiagoMGF