Seminar in Helsinki 19 January The relationship between national legislation and Regulations 883/2004 and 987/2009 Portuguese experiences in relation to healthcare
SOCIAL SECURITY SYSTEM CITIZENSHIP SOCIAL PROTECTION SYSTEM INSURANCE SYSTEM SUPPLEMENTARY SYSTEM Basic protection, solidarity nature, non-contributory Mandatory general Social security scheme Voluntary insurance scheme contributory Supplementary protection voluntary. Social assistance subsystem. Solidarity subsystem. Family protection subsystem
SOCIAL INSURANCE SYSTEM Aims at guaranteeing the payment of cash benefits to compensate for the loss or reduction of work earnings when the events legally set up occur The right to benefits depends on the affiliation of workers and employers or of self-employed and on the completion of minimum periods of contribution or equivalent
SOCIAL INSURANCE SYSTEM EMPLOYEES / SELF-EMPLOYED PERSONS - SICKNESS (cash benefits) - PARENTAL PROTECTION 1 - OCCUPATIONAL DISEASES - INVALIDITY - OLD-AGE - DEATH - UNEMPLOYMENT 2 - Health care (National Health Service) - ACC Work (mandatory private insurance) (1) maternity, paternity, adoption. (2) Employees and self-employed economically dependent workers, self-employed workers with business activities and administrators and managers.
The National Health Service (NHS) Article 64 of the Constitution of the Portuguese Republic of 1976 establishes the right of citizens to health protection materialised through an universal, general and tending towards free of charge NHS Law 56/79, of 15 September, created the NHS Law 48/80, of 24 August Health Framework Law
Main characteristics of the NHS NHS: Is universal as regards the population covered; Provides for integrated care or ensures that that care is provided; Is in general free of charge, taking into account economic and social conditions of citizens; Ensures equality of access for users, with the aim of mitigating the effects of economic, geographical and other inequalities in access to care Has regional organization and decentralized and participated management.
Health services - Type of care The NHS includes all the institutions and services dependent on the Ministry of Health with the objective of ensuring access of all the citizens to integrated health care, namely health promotion and surveillance, disease prevention, disease diagnosis and treatment, and medical and social rehabilitation of patients, subject to the available human, technical and financial resources The Ministry of Health may conclude contracts with private entities or private providers whenever necessary or advantageous cost-benefit ratio - to provide health care to the beneficiaries of NHS provided that the right of access is guaranteed
Health services - Type of care Health care by the NHS is guaranteed by a network of health services that includes: Primary Health Care (local health centres) Hospital Care Continued Integrated Care
Organization The NHS has a decentralised regional structure, made up of 5 administrative regions in continental Portugal Two autonomous regions (Azores and Madeira) with autonomous governments also operate in obedience to the principles enshrined in the Constitution of the Portuguese Republic Each continental health region has its own administration structure, under the competency of the Ministry of Health, responsible for the compliance and the adequacy of the national health policy at regional level, as well as for its implementation, co-ordination and evaluation at all levels of health care delivery
Funding The NHS is funded by the Ministry of Health through the State Budget The main funding source for the NHS comes from general taxation User fees may be applicable (and constitute SNS s own revenue) but the aim is to moderate access to health care (a wide range of exemptions is established: general exemptions/exemptions due to economic and social situations)
Beneficiaries of the NHS Portuguese nationals Nationals of EU Member-States according to the applicable EU rules Nationals of third countries legally residing in Portugal or under conditions of reciprocity Refugees and stateless persons legally residing in PT, under the same conditions as PT nationals
NHS - some figures (2016) Number of persons covered national register of users of the NHS: Age group Beneficiaries State budget for NHS: < 20 1 918 105 [20-65[ 5 927 564 > 65 2 189 979 10 035 648 9% of GDP, around nine thousand million
Overview NHS - Interaction with EU Regulations Portuguese citizens in EU countries EU citizens in Portugal Characteristics and trends over the years (Data taken from reports on emigration and immigration 2016)
Portuguese migration - Main indicators 2016 or last year available Country Entries of PT citizens Resident PT citizens who were born in PT Residents with PT nationality Germany 8,810 112,430 136,080 Austria 561 2,615 3,213 Belgium 3,442 35,249 44,166 Denmark 656 2,457 2,780 Spain 7,646 100,027 91,371 France 18,700 615,573 530,557 Netherlands 1,961 16,868 19,384 Ireland 426 3,866 4,807 Italy 354 6,305 6,088 Luxembourg 3,355 60,897 93,100 Norway 427 3,166 4,094 United Kingdom 30,543 131,000 213,000 Sweden 380 3,775 2,527 Switzerland 10,123 216,378 268,660
Main destination countries % of Portuguese citizens entries - 2016 or last year available Country Entries of foreign citizens N Entries of Portuguese citizens % of PT citizens in entries of the foreign citizens Relative position Germany 1,751,360 8,810 0.5.. Austria 158,746 561 0.4.. Belgium 149,155 3,442 2.3.. Denmark 90,961 656 0.7.. Spain 534,574 7,646 1.4.. France 235,000 18,700 8.0 1.º Netherlands 199,091 1,961 1.0.. Ireland 76,888 426 0.6.. Italy 280,078 354 0.1.. Luxembourg 22,888 3,355 14.7 2.º Norway 58,508 427 0.7.. United Kingdom 824,782 30,543 3.7 7.º Sweden 163,005 380 0.2 Switzerland 167,407 10,123 6.0 4.º
Entries of Portuguese citizens main destination countries - 2016 or last year available United Kingdom France Switzerland Germany Spain Belgium Luxembourg Netherlands Denmark Austria Norway Ireland Sweden Italy 0 5000 10000 15000 20000 25000 30000 35000
EU citizens in PT the most representative nationalities
NHS - Interaction with EU Regulations PT workers/self-employed in another MS During temporary stay in PT (article 19 Reg 883/2004 + article 25 Reg 987/2009) EHIC should be required but most of them are already users of NHS on the basis of national legislation (no reimbursement in many cases)
NHS - Interaction with EU Regulations Members of the family of PT workers/selfemployed in another MS Residence in PT (article 17 Reg 883/2004 + article 24 Reg 987/2009) S1/E109 should be required but most of them are already users of NHS on the basis of national legislation (no reimbursement in many cases)
NHS - Interaction with EU Regulations PT citizens that are pensioners with only one pension from another MS when they return to PT, and members of their families Residence in PT (articles 25/26 Reg 883/2004 + article 24(3) Reg 987/2009) S1/E121 should be required but most of them are already users of NHS on the basis of national legislation (no reimbursement in many cases)
NHS - Interaction with EU Regulations EU citizens in Portugal Workers/self-employed and members of the family equality of treatment all workers regardless of nationality under national legislation Pensioners EU Regulations apply
NHS - Interaction with EU Regulations EU citizens in Portugal non actives persons receiving private pensions (not covered by EU Regulations as pensioners no reimbursement) pure non actives
Interaction with EU Regulations EU citizens in Portugal - non actives interaction EU Regulations / Residence Directive 2004/38 legal residence no case law on healthcare article 7 Directive 2004/38: have sufficient resources for themselves and their family members not to become a burden on the social assistance system of the host Member State during their period of residence and have comprehensive sickness insurance cover in the host Member State universal system for residents - equal treatment entitled to access NHS under the same conditions as PT nationals
Challenges - verification of priority rights in another MS Portuguese citizens - Cooperation with other MS bilateral agreements information on pensions only from the other MS more difficult when the other MS has several regimes and institutions (e.g. France) - Information on S1 issued not always possible/not always issued EESSI? - Difficulties in verifying habitual residence
Challenges - verification of priority rights in another MS Private pensioners - Information to the persons concerned on priority rights - Control activities when they reach 65 and in following years (to confirm possible entitlement to a public pension in another MS) - Administrative and financial charges
Seminar in Helsinki 19 January Thank you! Elisabete Silveira