SPC365

Funding in arrhythmia: evolution of prices of complementary diagnostic methods in cardiology in ACSS and ADSE

Session: Sessão de Posters 19 - Temas quentes em pacing e eletrofisiologia na era atual
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: Posters Eletrónicos
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

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Times New Roman&quot;,serif">INTRODUCTION:</span></strong><span style="font-family:&quot;Times New Roman&quot;,serif"> Complementary diagnostic exams (CDE), in cardiology account for a substantial share of healthcare expenditure and are reimbursed according to different fee schedules issued by the Central Administration of the Health System (ACSS) and by the public health insurance scheme for civil servants (ADSE).&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Times New Roman&quot;,serif">OBJECTIVE</span></strong><span style="font-family:&quot;Times New Roman&quot;,serif">: To compare, in nominal and real terms, the tariffs assigned by both payers&nbsp;to the main cardiology CDE between 2021 and 2025.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Times New Roman&quot;,serif">METHODS:</span></strong><span style="font-family:&quot;Times New Roman&quot;,serif"> We carried&nbsp;a descriptive, retrospective study based on the official ACSS and ADSE tariff lists for CDE, covering EKG, 24-hour Holter monitoring, ambulatory blood pressure monitoring (ABPM), exercise stress testing (EST), transthoracic echocardiography (TTE) with and without Doppler, and transoesophageal echocardiography (TOE). Annual tariffs were collected and converted into 2024 euros using the consumer tariff index from Statistics Portugal. Absolute and relative differences and the ADSE/ACSS tariff ratio were calculated.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Times New Roman&quot;,serif">RESULTS:</span></strong><span style="font-family:&quot;Times New Roman&quot;,serif"> In every year, ADSE reimbursed at higher levels than ACSS for ECG, Holter monitoring, EST and TTE without Doppler. In 2024, the ADSE/ACSS ratio ranged from 105.9% for Holter monitoring to 188.3% for TTE without Doppler and was 147.0% for ECG and 154.2% for the EST (figure 1). In absolute terms, this corresponded, to &euro;5.7 vs &euro;3.9 for ECG, &euro;36.7 vs &euro;34.6 for Holter monitoring, &euro;42.5 vs &euro;27.6 for the exercise stress test and &euro;76.6 vs &euro;40.7 for TTE without Doppler. Despite these relative differences, real tariffs decreased for both payers between 2021 and 2024: real variation was &minus;8.9% for ECG and the exercise stress test, &minus;8.8% for Holter monitoring and &minus;13.2% for TTE without Doppler, with an identical &minus;13.2% reduction in ACSS tariffs for all four examinations. In 2025, marked asymmetry was observed for other procedures: the ADSE tariff for ABPM was around 44% lower than the ACSS contracted tariff, whereas TTE with Doppler maintained a differential in favour of ADSE (approximately 44% higher). For transoesophageal echocardiography, the ADSE tariff was about 28% lower than the ACSS/SNS tariff (table 1).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Times New Roman&quot;,serif">CONCLUSIONS:</span></strong><span style="font-family:&quot;Times New Roman&quot;,serif"> There is a&nbsp;misalignment between ACSS and ADSE tariffs for cardiology CDE, with ADSE reimbursing, on average, around 50% more than ACSS&nbsp;but with important exceptions such as ABPM and TOE. The reduction in tariffs in real terms, reflected in the real change (</span><span style="font-family:&quot;Times New Roman&quot;,serif">&Delta;</span><span style="font-family:&quot;Times New Roman&quot;,serif">) values in Table 1, suggests erosion of funding in a context of inflation and pressure on human and technological resources. A coordinated, inflation-indexed review of fee schedules, alignment between payers, and monitoring of the impact of these differentials on service organisation,&nbsp;appear essential to promote greater equity, transparency and sustainability in cardiology. This work illustrates the usefulness of simple economic analyses based on administrative data to inform negotiation and regulatory processes concerning CDE.</span></span></span></p>