Parliamentary Group

Assembly of the Republic-Palace of S. Bento-1249-068 Lisbon-Phone: 21391 9233-Fax: 21391 7456 Email: gpcds@pp. parlamento.pt-http://cdsnoparlamento.pp. parliamento.pt

DRAFT LAW NO. 47 /XI

TOTAL EXEMPTION FROM MODERATING RATES IN OUTPATIENT SURGERIES

AND IN INTERNSHIPS

The concept of outpatient surgery comes in at the beginning of the 60. Since then, it has been coming to

develop exponentially. At present, and in the face of the surgical interventions carried out in

internment scheme, the European average of outpatient surgeries is 55%, and from 75% in the

United States of America.

According to the National Commission for the Development of Ambulatory Surgery, the surgery of

ambulatory provides the improvement of patients ' access to surgery, through the reduction of lists

of surgical waiting.

This is certainly an advantage to be highlighted in the outpatient surgery, but it is not the only one. To this

type of surgery add up, too, health, social and economic advantages, internationally

recognized and that it is never too much to recall:

-Health advantages:

 At the clinical level, this type of surgery ensures a lower number of acquired infections in

medium to hospital which results, too, in a lower incidence of post-

operatorics, such as respiratory, thromboembolic and gastrointestinal;

 At the organisational level, a gain of efficiency in the achievement of the programmes is recorded

surgical, enabling the reduction of the extensive waiting lists for surgery;

 The release of the traditional operating blocks allows to reduce waiting times for the

more complex or urgent surgeries.

-Social advantages:

 In the first place, the ambulatory surgery causes a smaller break from the normal environment

family of patients, in particular in the cases of pediatrics and geriatrics;

 Second, there is a quick professional integration, with more repercussion

important in the adult population, professionally active;

 In third place, a greater humanization is ensured in the provision of health care,

through the creation of the specific and functional units for the realization of the surgery

ambulatory that provide greater individualization in assistance;

 The fact that there is no separation with the normal environment of the utent, provides it

a recovery with more humanization and convenience, allowing for a greater

involvement of the family in this process.

-Economic advantages:

 The ambulatory surgery ensures direct savings, by reducing costs

hospital related to the occupation of the operating blocks and internment. Calculates-

if the reduction in costs is between 40% and 80%, depending on the type of

intervention and the place where it is practiced;

 Checks, too, an indirect cost reduction because the interventions in

ambulatory result in a lower morbidity and a faster social integration of the

patient.

However, and with these advantages by all already recognised, in Portugal only 22% of surgeries

are carried out in an ambulatory regime. Thus, it is urgent to develop measures of

incentive to outpatient surgery, not only from health units but, also, from the

utente.

On the one hand, it matters to stimulate the offer:

-by proceeding to the necessary adaptations in services and health units;

-creating criteria for surgical, medical and social selection, so that a suitable one can be made

prior assessment of users;

-by devising effective awareness campaigns with the aim of informing users of form

a which, always medically viable, can opt for outpatient surgery.

On the other hand, it is to privilege and promote outpatient surgery, too, on the part of the

search. In a country where moderating fees are paid by any health service and in which if

establishes a moderating rate of € 5.20 for all and any outpatient surgery, is urgent

that there is willingness and political courage to improve the conditions of access for users to the

health care.

Outpatient surgery brings economic benefits to the state, it only has advantages for welfare

and for the recovery of users, our health services are in a position to be

quickly prepared to perform them and this type of surgery drastically reduces the waiting list

for the surgeries in internment regimen. It is, then, urgent to motivate their growth in

Portugal.

In the past Legislature, the CDS-PP submitted to Parliament a Draft Law that was aimed at the exemption

total of moderating rates in outpatient surgeries and which was rejected by the majority of the Party

Socialist. To corroborate that rejection, the Minister of Health claimed that " there is a character

educational and pedagogical and that all citizens have to be aware that health is expensive and that

we all contributed to her ". Position, incidentally, reiterated by the Socialist Party that at the time of the

discussion in generality, in the past February, stated that " moderating rates are

an important means to discipline and guide the search for a good that, by its essentiality,

has to be the subject of the best adjustment of the needs to the provision of the necessary care ". More

yet, stated that " a National Health Service as we understand it is not compadent with

surgical measures and electioneering such as the proposed ones; it needs to be measured instead

sustained and sustainable reorganisation, such as those that this Government has been putting in place ".

To the contrary, he recently spoke to the media the former Minister of Health,

António Correia de Campos, stating that " finished the political cycle, I see no reason to keep up

the moderating rates. I would do it myself if I were in the Government ". It states, still, the former Minister who

" extending the moderating rates to surgery and internment was carried out at a time in

that there were no certainties about the sustainability of the National Health System. He subsequently saw-

if the revenues charged were negligible, although they had the effect of disciplining them

collections and hospital services and value their action (...) ".

Ora, as contrary to what has been stated by the ER less than a year ago, the CDS-PP has not submitted

their initiative with the aim of being a " surgical measure and electioneering ", but yes because, by

all the reasons mentioned above, we believe it is paramount to promote outpatient surgery

in Portugal.

We believe, yet, that the moderating rates for internment, introduced with the Budget

of State 2007 are devoid of usefulness once, on the one hand, the internment stems from

a clinical decision and not of a will likely to be "moderate". On the other hand, as

stated recently António Correia de Campos, these fees came to be revealed " insignificant "

in terms of revenues raised.

In the face of the exposed and under the constitutional standards, the CDS-PP presents the following Project of

Law:

Article 1º

Article 148º of the Law No 53-A/2006 of December 29 is hereby repealed

Article 2º

Article 160º of the Law No 64-A/2008 of December 31 is hereby repealed

Article 3º

This Law shall come into force on the January 1, 2010.

Palace of Saint Benedict, November 11, 2009.

The Deputies,