New Public Management in the Portuguese health sector: a comprehensive reading

Abstract

We present an analysis of the main orientations that have guided the introduction of the New Public Management principles in the Portuguese health sector. Despite of being a result of international dynamics we also equate some national institutional characteristics such as a delayed and unfinished Welfare State and a centralized structure in political decision making that configures in a particular way the Portuguese health sector reform. Five main dynamics are here identified: dece ntralization of competences, financing and accountability, rationalization of expenses, deregulation of the labour market and internal competition and differentiation in the NHS. One of the most important arguments that we stress is that the health reform pursued in Portugal over the last decades has followed an ideological convergence despite today's growing uncertainties about the f uture of the Portuguese NHS, moving between Beveridge and Bismarck principles and dealing with an emergent for-profit sector that is allowed to act in competition with public sector.