{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T01:25:16Z","timestamp":1777857916621,"version":"3.51.4"},"reference-count":49,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2019,1,24]],"date-time":"2019-01-24T00:00:00Z","timestamp":1548288000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Int J Health Serv"],"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:p>Portugal has faced an economic and financial crisis that began circa FY2009 and whose effects are still ongoing. In FY2011, the Portuguese state and the European triumvirate \u2013 composed of the European Commission, the International Monetary Fund, and the European Central Bank \u2013 signed the Memoranda of Understanding. This troika agreement aimed to improve the operational efficiency of public services. This crisis had a considerable impact on the Portuguese citizens\u2019 life and productivity, as well as on the public health care system. Cuts over public expenditures have been made to reduce the risk of noncompliance with budgetary targets, despite their potential impact on quality and access to health care services. We analyzed the main policies and measures undertaken by the Portuguese Ministry of Health with respect to the bailout program associated with the troika agreement. Then, we focused on the budgetary cuts\u2013related risks over the social performance of the care system. Evidence suggests that structural reforms in the health care sector in the troika period had positive effects in terms of drugs administration and consumption, on the one hand, and secondary care expenditures reduction, on the other hand. Nonetheless, we observed some divestitures on infrastructures and the worsening of access to health care services.<\/jats:p>","DOI":"10.1177\/0020731418822227","type":"journal-article","created":{"date-parts":[[2019,1,24]],"date-time":"2019-01-24T20:31:57Z","timestamp":1548361917000},"page":"237-259","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":26,"title":["Financial Crisis in Portugal: Effects in the Health Care Sector"],"prefix":"10.1177","volume":"49","author":[{"given":"Alexandre","family":"Morais Nunes","sequence":"first","affiliation":[{"name":"CAPP, Instituto Superior de Ci\u00eancias Sociais e Pol\u00edticas, Universidade de Lisboa, Lisbon, Portugal"},{"name":"CERis, Instituto Superior T\u00e9cnico, Universidade de Lisboa, Lisbon, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5418-9337","authenticated-orcid":false,"given":"Diogo","family":"Cunha Ferreira","sequence":"additional","affiliation":[{"name":"CERis, Instituto Superior T\u00e9cnico, Universidade de Lisboa, Lisbon, Portugal"}]},{"given":"Adalberto","family":"Campos Fernandes","sequence":"additional","affiliation":[{"name":"Escola Nacional de Sa\u00fade P\u00fablica, Universidade Nova de Lisboa, Lisbon, Portugal"}]}],"member":"179","published-online":{"date-parts":[[2019,1,24]]},"reference":[{"key":"bibr1-0020731418822227","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthpol.2008.11.008"},{"issue":"4","key":"bibr2-0020731418822227","first-page":"1","volume":"13","author":"Barros P","year":"2011","journal-title":"Health Syst Transit"},{"key":"bibr3-0020731418822227","volume-title":"Funding Health Care: Options for Europe","author":"Mossialos E","year":"2002"},{"issue":"2","key":"bibr4-0020731418822227","first-page":"1","volume":"19","author":"Sim\u00f5es J","year":"2017","journal-title":"Health Syst Transit"},{"key":"bibr5-0020731418822227","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthpol.2012.04.008"},{"key":"bibr6-0020731418822227","unstructured":"Eurostat. GDP and main components (output, expenditure and income). http:\/\/appsso.eurostat.ec.europa.eu\/nui\/show.do?dataset=nama_10_gdp&lang=en. Published 2017. Accessed January 4, 2019."},{"key":"bibr7-0020731418822227","unstructured":"INE. Conta Sat\u00e9lite da Sa\u00fade. https:\/\/www.ine.pt\/xportal\/xmain?xpid=INE&xpgid =ine_destaques&DESTAQUESdest_boui=281092804&DESTAQUESmodo=2. Accessed January 4, 2019."},{"key":"bibr8-0020731418822227","unstructured":"Eurostat. Government finance statistics. Government deficit and debt. http:\/\/appsso.eurostat.ec.europa.eu\/nui\/show.do?dataset=gov_10dd_edpt1&lang=en. Published 2017. Accessed January 4, 2019."},{"key":"bibr9-0020731418822227","unstructured":"Portugal - Memorandum of understanding on specific economic policy conditionality. 17 May 2011. https:\/\/resistir.info\/portugal\/memo_troika.pdf. 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