This SNS is not for white people

This NHS is not for white people, which is a metaphor for the middle class. This means that the major problems and constraints affecting the NHS don't actually affect the government or the polls, and opposition parties won't gain much by capitalizing on this problem. This is because we should focus not on the problem itself, but on those affected by it.

If we consider that private health insurance in Portugal covers approximately three and a half million Portuguese; if we consider that ADSE (Sickness Assistance for Civil Servants of the State) has approximately one and a half million beneficiaries, including current employees, retirees, and their families; if we factor in another two hundred thousand other government employees, such as GNR (National Republican Guard) soldiers or PSP officers, who benefit from other subsystems such as SAD (Sickness Assistance Services); and if we calculate that there are approximately 60,000 bank employees and their families in Portugal who could be users of the SAMS system, how many Portuguese are left without public or private health insurance?

These Portuguese people complain about the high cost of living because they have to have insurance and pay taxes to access a public health service they don't use, but that's not the topic of this article.

Now let's consider the number of patients without a family doctor, although this isn't a problem that bothers the government much either, as it simply doesn't give much importance to the existence of this professional class. The figures quoted are approximately one million seven hundred thousand "citizens" without a family doctor. Now, as Prime Minister Dr. Luís Montenegro rightly pointed out, the number of citizens with a family doctor has been increasing, but the problem is that the number of "citizens" without a family doctor has also increased. Since women aren't having more children, the only explanation is immigration.

Since the immigrant community is mostly poorer than the middle class in the host country, they are also unlikely to have health insurance.

Therefore, the electoral weight of having a middle class well-equipped with healthcare services is quite different than having a more deprived or immigrant population. The immigrant community votes less. And this prevents the government from focusing on healthcare. All the reports we see, hear, and read about pregnant women who miscarry are from the lower classes, because middle-class women either monitor their pregnancies with their family doctor (which they have), and deliver privately, or entirely privately. Even without insurance, with follow-up care from their family doctor and ultrasounds privately, because it's also very difficult to get them at a government-run clinic, they can manage to spend around three thousand euros over nine months. And the middle class, who only have one or two children at a later age, can handle that. Of course, there are also lower-middle-class users who are not entirely satisfied with health services, surgery waiting times, or oncological responses, but these issues must be evaluated from different perspectives. Serious acute situations such as an acute myocardial infarction or a stroke continue to have a very good response in the NHS, even in the most pressured units. The number of citizens residing in Portugal has remained more or less stable for 50 years. It's the same ten million. One and a half million emigrants left, and the same number of immigrants entered. The number of healthcare professionals has also remained more or less stable, considering new arrivals versus retirements. The problem lies in where these professionals are. Solving the NHS's problems, without considering debts to suppliers and focusing solely on access, requires short- and medium-term political decisions. In the short term, for secondary healthcare, there are three options: nationalization of private hospitals, which I don't think is a good idea; rehiring professionals for the NHS, which was the measure taken now for the obstetrics service at Garcia de Orta Hospital; or public-private partnerships. It seems logical to me that the decision should fall on these last two. In primary care, the solution will be even simpler: it will involve a drastic reduction in the metrics by which doctors are evaluated, a drastic reduction in bureaucracy and the hours wasted on preparing protocols, reports, prescribing chronic prescriptions, recording exams, meetings, committees, responding to emails, and then using those hours to consult patients without medical assistance. It seems simple to me. What sense does it make for a family doctor to have to observe a child or pregnant woman and therefore be evaluated, when that child or pregnant woman is already being seen in a private hospital? Or when hypertensive and diabetic patients are already being seen in a public hospital?

Evaluate the actual number of hours a doctor spends in consultations versus the number of hours spent on the tasks described above. Add it all up over a year and multiply it by the number of family doctors nationwide. That would be a lot of consultations provided to those who need them most.

Only after these practical measures can we talk about medium and long-term measures that will only have a return in a few years, such as increasing the numerus clausus in faculties or making it mandatory for doctors trained in the NHS to stay in that same NHS for a certain number of years, although the latter may not be legal in light of European legislation. The numbers are known, the problems are identified, and the solutions are as well. What's missing is the political will and/or courage to implement them.