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Twenty five years of cardiology tariffs in the Portuguese National Health Service: who gained and who lost value?
Session:
Sessão de Comunicações Orais 09 – Inteligência Artificial e tomada de decisão no risco cardiovascular e nos sistemas de saúde
Speaker:
Didier Martinez
Congress:
CPC 2026
Topic:
N. E-Cardiology / Digital Health, Public Health, Health Economics, Research Methodology
Theme:
34. Public Health and Health Economics
Subtheme:
34.3 Health Economics
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Didier Martinez; Gonçalo Ferraz-Costa; Tatiana Santos; Maria João Primo; Ana Rita Ventura; Inês Brito e Cruz; Elisabete Jorge; Rui Baptista; Lino Gonçalves
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>INTRODUCTION:</strong> Cardiology Diagnostic Procedures (CDP) are central to clinical practice in the Portuguese National Health Service (Portuguese-NHS) and are reimbursed by regulated fee schedules, whose evolution is poorly quantified and relevant for health-economics analysis.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>OBJECTIVES:</strong> To characterise, for 2000–2025, the evolution of nominal and real tariffs of main cardiology procedures in the Portuguese-NHS and the impact of fee-schedule ministerial decrees.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>METHODS:</strong> Descriptive study of the CDP fee schedule from procedures: 12-lead EKG, ambulatory blood pressure monitoring (ABPM), 24-/48-hour Holter, exercise stress test, transthoracic echocardiography (TTE) with/without Doppler, transoesophageal echocardiography (TOE) and cardiac Doppler) and of the Consumer Price Index (CPI-INE) for 2000–2024. Procedures were grouped as “simple” (EKG, ABPM and Holter) or “complex” (cardiac Doppler, TOE, both TTE, exercise test). Nominal tariffs (prices extracted from ACSS) were inflation ajusted prices with CPI (2024 = 100), enabling comparison between the mean tariff index of the procedures and the CPI.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>RESULTS:</strong> Majority of procedures underwent two tariff changes, mainly in 2009 and 2013, otherwise with nominal stagnation (Figure 1). Between the base year and 2024, 9/11 procedures had nominal reductions (median −33%, range −78% to +21%). The largest cuts affected TTE (−65% to −76%) and exercise tests without gas analysis (−72% to −78%); cardiac Doppler (+21%) and ABPM (+2%) were relatively protected. The TTE with/without Doppler tariff ratio fell from 2.0 to 1.4 and the TOE/EKG ratio from 50 to 42–43. User charges were not reduced, increasing the share paid by patients for EKG and exercise tests. In real terms, the mean tariff index fell from ≈281 in 2000, while the CPI rose from ≈61, showing that cardiology test tariffs did not follow the general tariff level (Figure 2).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>CONCLUSIONS:</strong> Cardiology diagnostic tariffs in the Portuguese-NHS underwent major revisions with strong relative tariff cuts for several examinations, followed by long periods of nominal stability. Real-term analysis reveals sustained compression of the relative tariffs of these procedures, with continuous real erosion during years of static nominal tariffs. Although utilisation and outcomes were not analysed, the results suggest altered incentives between simple and complex examinations and a higher financial burden for patients. Further studies linking tariffs, volumes, costs and outcomes are required to assess the alignment of current tariffs with sustainable and equitable cardiology care.</span></span></p>
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