Health policy reform in tough times: the case of Portugal.

The financial rescue plan for the Portuguese economy details a number of adjustments to be made in the National Health Service. We review the changes on user charges. The requirement of the rescue plan on user charges is twofold: structure of user charges and the levels of user charges. Adoption of measures occurred within the timeframe required. The first part, structure of user charges, is already present in the Portuguese NHS and has been for a decade. The crucial decisions are therefore on the level of user charges. Increases in levels of user charges were substantial (roughly doubling their previous levels) although exemptions also expanded considerably the fraction of the population that is not required to pay user charges. The net effect is not clearly predictable.