{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T15:23:39Z","timestamp":1775057019221,"version":"3.50.1"},"reference-count":33,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2022,10,17]],"date-time":"2022-10-17T00:00:00Z","timestamp":1665964800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>The Portuguese health system has a universal, public, general National Health Service (NHS), tending towards free healthcare access. Created in 1979, this delivery model developed from the integration and complementarity between the different response levels (primary, hospital, continuing, and palliative care). However, over the last 40 years, the initially centralized system underwent a decentralization process with the creation of Regional Health Administrations in the five mainland administrative regions. Since then, the entire NHS has settled around this new organization. The most recent step started in 2018 with the decentralization of primary healthcare skills to 190 municipalities. This paper presents the various critical issues involved in the latest gradual decentralization process in health, intending to bring services closer to the citizens, and to be more focused on their needs. The article identifies and discusses the implications of this experience based on the steps foreseen in the already-published legal texts.<\/jats:p>","DOI":"10.3390\/ijerph192013390","type":"journal-article","created":{"date-parts":[[2022,10,17]],"date-time":"2022-10-17T21:11:51Z","timestamp":1666041111000},"page":"13390","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["A Critical Analysis of Decentralizing the Portuguese Public Healthcare Provision Services"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6808-7769","authenticated-orcid":false,"given":"Alexandre Morais","family":"Nunes","sequence":"first","affiliation":[{"name":"Centre for Public Administration and Public Policies, Institute of Social and Political Sciences, Universidade de Lisboa, Rua Almerindo Lessa, 1300-663 Lisbon, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5418-9337","authenticated-orcid":false,"given":"Diogo Cunha","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Centre for Public Administration and Public Policies, Institute of Social and Political Sciences, Universidade de Lisboa, Rua Almerindo Lessa, 1300-663 Lisbon, Portugal"},{"name":"CERIS, Instituto Superior T\u00e9cnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001 Lisbon, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1080\/13597560902753537","article-title":"The Partisan Logic of Decentralization in Europe","volume":"19","author":"Sorens","year":"2009","journal-title":"Reg. Fed. Stud."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1017\/S1744133105001209","article-title":"Conceptualizing decentralization in European health systems: A functional perspective","volume":"1","author":"Saltman","year":"2006","journal-title":"Health Econ. Policy Law"},{"key":"ref_3","first-page":"7","article-title":"Decentralization and privatization in Portuguese health reforms","volume":"4","author":"Campos","year":"2004","journal-title":"Rev. Port. 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Innovations in Health Care Delivery: Organizational Reforms within the Public Sector, The World Bank."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/20\/13390\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:55:42Z","timestamp":1760144142000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/20\/13390"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,17]]},"references-count":33,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2022,10]]}},"alternative-id":["ijerph192013390"],"URL":"https:\/\/doi.org\/10.3390\/ijerph192013390","relation":{"has-preprint":[{"id-type":"doi","id":"10.20944\/preprints202207.0147.v1","asserted-by":"object"}]},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,17]]}}}