Demande directe (CEACR) - adoptée 2006, publiée 96ème session CIT (2007)

Part II (Medical care) of the Convention. The Committee takes note of the new measures introduced to secure an improvement in the management of medical care and better governance of the health system, which is still in the process of reform. Order No. 418 of 14 April 2005 sets forth the organization and operation of the departments of the Health Regulatory Body (ERS) and the internal rules of each department. Order No. 1108 of 7 September 2004 approves the hospital classification list (central level, district level and level I) for the purpose of determining the value of the health benefits provided by the various institutions of the National Health Service. Council of Ministers resolution No. 84 of 27 April 2005 approves the principles underlying policy and reorganization as regards to health care for the elderly and for dependent persons, and sets up a committee to be in charge of the work involved. A working party has been established to study primary health-care reform. As to the financial management of the branch, Council of Ministers resolution No. 102 of 24 June 2005 provides for the adoption of measures to ensure the financial viability of the National Health Service, particularly as regards to state participation in the cost of drugs. As for sharing by patients in the cost of health care, Legislative Decree No. 173 of 1 August 2003 approves the legal framework for beneficiaries’ own contributions applying to health-care access within the National Health Service and defines the persons who are exempt from them. Order No. 985 of 13 September 2004, amended by Order No. 103 of 23 January 2004, approves the scale of own contributions. Order No. 310 of 23 March 2005 establishes the requirement for the various bodies reporting to the ERS to pay contributions and own contributions.

The Committee observes that the reforms undertaken by the Government are extensive. It recalls that, whatever the circumstances, governments must assume general responsibility for the sound administration of health institutions (Article 72(2) of the Convention) and for the provision of the medical benefits provided in compliance with the Convention, and must take all measures required for this purpose (Article 71(3)). To ensure the financial sustainability of the branch, they must ensure in particular that actuarial studies and calculations are made periodically and, in any event, prior to any change in benefits, in the rate of insurance contributions or in the taxes allocated to covering the contingencies in question, or the volume of the benefits themselves. Furthermore, in accordance with Article 71(1) of the Convention, any emergency or long-term measures must be implemented in a manner which avoids hardship to persons of small means and takes into account the economic situation of the classes of persons protected. As to the volume of the medical benefits provided, in seeking to optimize the financial and medical management of the branch, the Government must ensure that the benefits are not limited to curative medical care but aim also to maintain and improve the health of the protected persons (Articles 7 and 10(3) of the Convention), as far as possible by using the available general health services (Article 10(4)). The Committee draws attention in this connection to Recommendation No. 1626 (2003) of the Parliamentary Assembly of the Council of Europe on the reform of health-care systems in Europe, which states that “the main criterion for judging the success of health system reforms should be effective access to health care for all without discrimination, which is a basic human right. This also has the consequence of improving the general standard of health and welfare of the entire population”. Bearing this in mind, the Committee would like the Government to provide the texts of the abovementioned legislation, together with a detailed account of how the measures taken have affected the application of each Article of Part II of the Convention and ensure the long-term sustainability of the national health system. Please explain also how the efficiency of these measures is being monitored in terms of improvements they bring to service delivery and the state of health of the population and what criteria are used for this purpose.

Part XI (Standards to be complied with by periodical payments). (a) The report indicates that Directive No. 464/2006 of 22 May updated the coefficients for revaluation of remuneration to be used in revaluing the reference remuneration taken as the basis for pension calculations. The reference remuneration is indexed to the value of the average guaranteed monthly wage (RMMG) in force at the date of commencement of the pension. Minimum pensions are also indexed to the value of the RMMG. The Committee asks the Government to show, on the basis of the statistical data for the period since the introduction of the new rules for pension calculation by Legislative Decree No. 35/2002 of 19 February, that the established system of indexation linked to the RMMG guarantees the rate of adjustment of pensions required by Article 65(10) of the Convention and ensures the maintenance of the real value of the pension in relation to the cost of living.

(b) In accordance with the principle of periodic review of pension amounts, Directive No. 1316/2005 of 22 December undertook the annual revaluation of disability, old-age and survivors’ pensions and pensions for occupational diseases. Please indicate whether and how pensions for industrial accidents payable by the private insurance companies have also been revalued and adjusted in accordance with Article 65(10) of the Convention.

Part XII (Equality of treatment of non-national residents) in relation to Part VII (Family benefit). The Committee recalls that Legislative Decree No. 341/99 of 25 August has abolished the requirement of a qualifying period of six months of wages for the entitlement to the family benefit in the general social security regime, in accordance with Article 43 of the Convention. The report states that the reformed family benefit system covers Portuguese and foreign nationals, refugees or expatriates who fulfil the general and specific conditions for the award of benefits, which are not being subject to contribution history. The general condition of access is residence in the national territory. Access of non-Portuguese residents, refugees and expatriates may also be made subject to verification of certain conditions, such as the existence of minimum residence periods. Please indicate the duration of the required period of residence and supply the text of the corresponding provisions of the legislation.

[The Government is asked to reply in detail to the present comments in 2007.]