LISBON — Getting to the MRI machine at one among this metropolis’s largest public hospitals means taking a visit by time. Plastic ready room chairs in radiology sit amid centuries-old blue and white Azulejo tiles, whereas a close-by chapel glimmers with Renaissance statuary and work. Hospital de São José’s ambulance bays, examination rooms, and labs, in any case, occupy a former faculty the Jesuits began constructing in 1579.
This recycling of a timeworn campus that one way or the other survived Lisbon’s devastating 1755 earthquake exemplifies Portugal’s well being system: Instead of spending cash on gleaming new hospitals and costly drug therapies, the nation focuses on quaint main care and public well being.
It’s a technique that has served Portugal properly, and one which well being care specialists level to as a mannequin the United States would possibly be taught from because it confronts hovering medical prices and, by many measures, deteriorating well being.
Consider these numbers: Portugal has a life expectancy practically 4 years longer than the U.S. regardless of spending 20% of what the U.S. does on well being care per particular person. According to the 2021 Global Security Index, which measures the power to answer pandemics, Portugal ranked third out of 195 international locations in offering entry to inexpensive well being care. The United States ranked 183rd.
Portugal has a nationwide well being care system, entitling each resident to free or very low-cost well being care. “They handle folks. If you’re poor, you continue to get well being care. And you don’t need to have a job to get medical health insurance,” stated Kyriakos S. Markides, a professor of ageing on the University of Texas Medical Branch, Galveston. “What occurs on this nation? Lots of people go with out.”
Portugal isn’t with out challenges. A scarcity of main care doctors means lengthy waits for care, and greater than 1,000,000 folks, a lot of them immigrants, have no assigned physician. But STAT’s evaluation, primarily based on two weeks of reporting in Portugal and interviews with dozens of well being care employees, sufferers, and coverage specialists, discovered their system is nimble and makes good use of information and digital well being data to trace each particular person and inhabitants well being in actual time. It embraces progressive packages comparable to “social prescribing” that increase the boundaries of what’s thought-about well being care, whereas progressive legal guidelines on drug use and remedy have been credited with driving down overdose deaths, whilst they rose within the U.S.
Central to its success is a community of main well being care clinics embedded in neighborhoods, working alongside regional public well being models. Data circulation freely between them to trace diseases and unmet well being wants, stated Gustavo Tato Borges, president of Portugal’s National Association of Public Health Doctors.
While his nation could not supply probably the most cutting-edge, costly medical therapies, he instructed STAT the deal with main and preventive care is working — and never breaking the financial institution. “We have outcomes which are approach above what can be anticipated,” he stated. “Most of us can’t even think about what it prices to offer care in America. We in Portugal don’t wish to grow to be the U.S. We are most likely extra seduced by Holland and Germany.”
Portugal has come a good distance in a comparatively brief time. In 1950, life expectancy right here was nearer to 60, among the many lowest for developed nations. In the U.S. that 12 months, it was 70, stellar for the time and among the many highest on the planet. Today, the 2 international locations have swapped locations. Why?
It’s a vexing query — and one thing of an indictment of the United States, a powerhouse of biomedical analysis that spends extra on well being care than another nation — in 2022, $4.5 trillion, or $13,500 per particular person.
“We are a sick nation,” says Stephen Bezruchka, a former emergency doctor in Seattle who now researches and teaches on the University of Washington concerning the position inequality performs in harming well being and why spending extra on well being care doesn’t assist. If there have been a “well being Olympics,” he notes in his ebook “Inequality Kills Us All,” the United States would are available fiftieth.
Now at 78.5 years, life expectancy within the United States has stagnated. In 2021, it had dropped to its lowest level since 1996, in line with the Centers for Disease Control and Prevention, largely as a result of Covid deaths, and it’s nonetheless struggling to bounce back. The nation ranks about 60th among the many world’s nations, nearer to Turkey and Ecuador than to fellow financial powerhouses like Switzerland and Japan, the place folks stay to about 84 years on common. In Portugal, which spends about $2,700 per particular person on well being care yearly, folks stay 82.3 years on common.
Americans “die the youngest and stay the sickest,” in line with a report comparing 10 peer nations launched this 12 months by the Commonwealth Fund. “The United States,” the report’s lead writer and former basis president David Blumenthal instructed STAT, “is probably the most progressive — and dysfunctional — well being care system on the planet.”
If you ask specialists what’s behind that poor well being efficiency, you’ll hear a sort of “select your personal journey” primarily based on the analysis pursuits of these specialists. It’s gun violence. No, it’s toddler and maternal mortality. No, it’s racial well being disparities. No, it’s deaths of despair. No, it’s weight problems. No, it’s drug overdoses.
It’s all of these and extra, stated Stephen Woolf, a professor of household medication and inhabitants well being at Virginia Commonwealth University, who has analyzed such trends for many years and says the lives misplaced as a result of America’s failing well being system dwarfs these misplaced within the pandemic. In his analyses, each physique system, age group, racial group, and social class within the United States is doing extra poorly on common than it ought to — even white, college-educated Americans who ought to be thriving.
It’s not only a handful of ailments which are guilty, both. In addition to Covid-19 — which curbed U.S. life expectancy excess of in lots of different international locations — Woolf has discovered that 35 totally different causes of loss of life have elevated in current a long time.
“In each single area, we discovered issues within the U.S. … It’s systemic,” Woolf stated. “In Portugal, they aren’t experiencing these systemic issues.”
Portugal’s stellar progress comes as no shock to Atul Gawande, a physician-writer who serves as assistant administrator for world well being on the U.S. Agency for International Development. As a journalist, he chronicled the success of one other nation, Costa Rica, which additionally spends far lower than the U.S. on well being care but achieves outsized outcomes due to its related deal with main care and public well being.
Thailand, he stated, is one other nation that dramatically boosted well being outcomes by offering residents with entry to low-cost well being care, assigning them main care physicians, and creating a military of neighborhood well being employees. In simply twenty years, he stated, the nation has shifted from seeing 35% of its inhabitants die earlier than 50 to gaining 10 years in life expectancy; it’s now close to 80.
“This is a part of the story of Portugal,” he stated in an interview with STAT. And it could possibly be a narrative within the U.S. as properly, worldwide specialists say, if we altered our well being system to middle much less on costly hospital and specialty care, and mended the yawning gulf that exists between public well being and first care.
“Those international locations which have constructed round their main well being care facilities,” Gawande stated on the current STAT Summit, “have gotten phenomenal outcomes at a a lot decrease price.”
Portugal’s focus is unapologetically on main care. The spine of its well being system are “household well being models,” clinics pioneered in 2006 and sprinkled all through the nation. Their care groups grow to be a part of the neighborhood. They embody docs, nurses, social employees, and infrequently most critically, entrance desk workers who calmly work to assist coordinate appointments and hold streams of sufferers flowing.
On a current day on the Baixa Family Health Unit, in Lisbon’s energetic historic middle, sufferers of all ages from a panoply of countries flowed by, receiving what really is household care. “We comply with the entire household, from being pregnant till they’re lifeless,” stated Martino Gliozzi, the doctor who coordinates the middle. His oldest affected person is 104.
While a part of a nationwide well being system, clinic administrators have appreciable autonomy. When Gliozzi took cost in 2016, sufferers incessantly lined up within the early morning to be seen by a health care provider. He put an end to the lines with a system that distributed appointments all through the day and allowed extra sufferers to be seen.
For those that can’t get to the clinic, docs see sufferers at residence. Gliozzi stays match by negotiating Lisbon’s steep hills and house staircases, as do his clinic’s nurses. “We have older girls who stay on the third ground. They can’t do something by themselves. For them it’s actually necessary we go there,” stated Tânia Meneses, one of many clinic nurses.
Gliozzi, a local of Italy who has labored in Mozambique and Brazil, got here to Lisbon for his residency in 2009 and feels proper at residence within the well being unit, the place a dozen languages could be spoken in a day. Staff use Google Translate on their telephones, pointing at footage, waving their arms, and utilizing damaged English to speak with the numerous immigrants they serve. Patients who don’t have well being data or aren’t positive in the event that they’ve acquired vaccines are urged to get pictures, particularly for measles and tuberculosis. “Better protected than sorry,” Meneses stated.
The clinic embraces what Gliozzi calls “out of the field” concepts, like Walk with a Doc: Early within the night, physicians stroll metropolis streets with sufferers to encourage train. (Portugal, just like the U.S., faces an weight problems disaster regardless of its a lot more healthy seafood-forward Atlantic eating regimen — suppose Mediterranean eating regimen however with extra clams.)
Under the management of one other younger physician, Cristiano Figueiredo, the clinic was the primary within the nation to embrace “social prescribing” — utilizing affected person visits to ask about social points affecting their well being and begin to handle them by linking sufferers with the neighborhood sources they want. The follow is now spreading widely across Europe.
At one appointment, a younger man in his 30s, who requested that his title not be used to guard his privateness, got here in with itchy crimson arms, the pores and skin peeling off in strips. The rash was painful, maintaining him from his on-and-off job serving to construct momentary exhibition areas. Figueiredo decided the person had impetigo and prescribed an antibiotic cream. But reasonably than speeding him out the door and shifting to the subsequent case, Figueiredo frolicked studying the affected person’s well being data, and observed he hadn’t seen a doctor within the earlier 4 years. Electronic well being data comply with a affected person no matter how usually or the place they transfer inside Portugal.
He noticed the person had been smoking since he was 17 and had tried to stop a number of occasions. Figueiredo gently introduced this up. “I believe it’s essential for you as a result of your father handed away from lung most cancers,” he stated. “Do you wish to attempt quitting?” The affected person was prepared to attempt smoking cessation medication; regardless that they’d price him 80 to 90 euros out-of-pocket, they had been cheaper than tobacco. He was additionally prepared to do the STD scan Figueiredo urged.
“This affected person had very low contact with the NHS. We take the chance to do a little bit of preventive medication,” Figueiredo defined after the affected person left. He remained involved the person hadn’t completed faculty and labored irregularly. It was one thing he deliberate to debate with him when he returned for a follow-up go to. “It was my intuition, it wasn’t time,” he stated. “Maybe subsequent time.”
This nation’s well being statistics are all of the extra outstanding given its dismal circumstances only a half-century in the past. An authoritarian regime in energy from 1933 to 1974 had left the nation with the bottom per capita revenue and literacy charges in Western Europe. Infant mortality in 1975 was a devastating 45 deaths per 1,000 births and life expectancy hovered round 60.
During these years, famous Carlos Cortes, president of the Portuguese Medical Association, “we had a well being system largely for the wealthy — individuals who had been wealthy may go overseas.”
That all modified when the nation was remade right into a democracy 50 years in the past and a nationwide well being system was created, modeled on Britain’s. The proper to well being care was enshrined into Portugal’s new structure.
“We put everybody on the identical degree,” stated Cortes. Life expectancy rose by about 10 years. ”Very rapidly, Portugal went from not having a system to being among the finest. It was one of many greatest jumps ahead on the planet.”
How far Portugal has come grew to become clear in the course of the Covid pandemic. In the United States, efforts to deploy the vaccines that it had created in a blinding feat of technical prowess had been disappointing to many public well being leaders. Less than 70% of U.S. adults are totally vaccinated, in contrast with practically 90% in Portugal.
Vaccine hesitancy is minimal, because of the nation’s decades-long deal with childhood and grownup vaccination packages, however the Covid vaccine marketing campaign bought off to a rocky begin. Early efforts had been marred by folks with connections leaping the road and the unfold of misinformation. To hold the scenario from spiraling uncontrolled, the federal government handed the reins of the vaccination mission to Admiral Henrique Gouveia e Melo, an imposing former submarine squadron commander.
Wearing army fatigues meant to encourage belief, he appeared incessantly on tv to calm and encourage a frightened inhabitants. He approached the marketing campaign as he would a battle, he instructed STAT, in an interview in expansive workplaces overlooking the Atlantic Ocean and graced with hand-painted tiles depicting naval triumphs when Portugal commanded the world’s seas.
“I’m a submariner. I don’t know easy methods to defend. I solely know easy methods to assault,” stated Gouveia e Melo, now chief of the naval workers. “We needed to make this like D-Day.”
He deployed army mathematicians to optimize vaccine supply, partnered with mayors and village leaders, and commandeered iconic soccer stadiums for mass vaccination websites. Harnessing contact data from nationwide well being service data, his 300-person workforce contacted residents to come back in for appointments, typically badgering folks with three texts per day, and main Portugal to rapidly grow to be, to the surprise of many, one of many world’s most vaccinated international locations.
Such successes are one thing the Portuguese are rightfully happy with. “We got here from distress to a medium place in Europe,” Adelberto Campos Fernandes, who served because the nation’s well being minister from 2015-18, instructed STAT, noting Portugal’s built-in networks of main care, excessive vaccine uptake, and spectacular toddler and maternal well being statistics.
It’s not all tied to cash, he notes. Despite rating fortieth economically, Portugal ranks 14th amongst European nations in well being metrics, and in a lot of these metrics, surpasses the U.S. Fernandes stated he doesn’t see life expectancy and different well being indicators enhancing within the U.S. until politicians handle inequalities that permit the rich and well-insured to decide on amongst high hospitals to have elective procedures whereas others don’t obtain even fundamental care.
“At the identical time,” he stated, “you’ve gotten the very best care on the planet, and the worst.”
Portugal’s well being care system is way from excellent. It’s a perennial problem in elections, and docs’ and nurses’ strikes are widespread. Headlines ominously warn of “an imminent breakdown,” whereas a vital scarcity of physicians has left practically 1.6 million of the nation’s 10 million residents with no household physician, that means they usually wait weeks or months for an appointment.
The physician scarcity is partly an issue of demographics, as those that began their careers on the daybreak of the nation’s well being system retire and aren’t changed. It’s additionally an issue of low pay, significantly in Lisbon and coastal Nazaré, costly areas the place physicians usually have problem affording properties. Many docs and nurses have taken jobs in higher-paying Northern European international locations. It may additionally be an issue of low efficiency and what number of sufferers every doctor sees.
The result’s strains. Lines to get elective surgical procedures, and contours snaking out clinic doorways. Early one current chilly and foggy morning, about two dozen folks had been already queued up exterior a clinic in Amadora, a largely immigrant neighborhood about midway between Lisbon and the palace-studded former royal sanctuary of Sintra. They had been hoping to snag a scarce appointment when the clinic opened its doorways.
One girl who requested that her title not be used, was sporting a vivid blue wool coat over a cumbersome sweatshirt, and coughing miserably. The 67-year-old had been in line since 4 a.m. She’s gotten used to ready, she stated, although it has left her pissed off and offended. She shook her head as she checked out a photograph on the telephone of one other affected person that confirmed a line wrapping across the constructing throughout flu season.
Her technique labored. Once sufferers had been let in at 8 a.m., she was out in lower than an hour, having gotten remedy for her cough. She misplaced her household physician a number of years in the past for causes she doesn’t totally perceive as a result of her husband nonetheless has a health care provider. She earns little working for a personal charity and stated she will’t afford personal insurance coverage or to pay to see personal docs.
“I’ve at all times paid taxes. I’ve been working since I used to be 14 and I nonetheless work, however I don’t come up with the money for,” she stated in Portuguese by an interpreter. “How are you able to count on me to pay for checks and consultations?”
She left then, to choose up her prescription cough medication, and to relaxation. But she returned a couple of minutes later, involved about what would occur if one thing damaging was written. “Please don’t terminate the National Health Service,” she instructed STAT. “It’s the one probability the poor folks get.”
Even these with household docs should look forward to some providers comparable to elective surgical procedures. Mohammed, 53, a affected person on the Baixa clinic who moved to Portugal from Bangladesh about 5 years in the past, has been coping with the discomfort of a fistula for months. He was given a ready time of 9 months since his case was not deemed pressing. Carrying an organized sheaf of medical data in a transparent plastic folder, he instructed his doctor, Figueiredo, that he’d visited two hospitals hoping to be seen sooner however was instructed no.
Some middle-class and wealthier Portuguese have elected to pay for personal insurance coverage, partly to bypass the waits for surgical procedure. (Some public staff get personal medical health insurance as properly.) The personal hospitals they will go to are sometimes new and gleaming. A stroll by one in Lisbon revealed modern ready rooms full of Scandinavian type furnishings, big video screens, partitions of plants, and escalators that whispered as they carried sufferers between flooring. But it additionally felt impersonal, like a Department of Motor Vehicles ready room, with dozens of affected person numbers slowly scrolling by on screens.
Some personal suppliers, in line with sufferers and National Health Service physicians, are desirous to carry out easier procedures that end in fast earnings, like hip replacements, however much less desirous to tackle extra complicated, time-consuming points or high-risk maternity instances. That can lead insured sufferers to return to the general public system for care, including to the monetary pressures it faces.
“Across the area, personal suppliers take the straightforward instances as a result of they’re there to earn money,” stated Jon Cylus, a senior well being economist on the World Health Organization and a researcher on the European Observatory on Health Systems and Policies who previously labored for the U.S. Centers for Medicare and Medicaid Services. “Often it erodes the general public system. It’s a vicious downward cycle.”
The U.S. has a vital lack of main care physicians as properly. About 100 million Americans — one third of the inhabitants — face barriers accessing primary care, with the issue solely worsening with time and with no actual resolution in sight. In Portugal, they’re engaged on solutions, a few of them fairly unorthodox.
Family well being doctor Alexandra Fernandes and nurse Olívia Matos had comfy jobs offering care at a household well being unit in Fernão Ferro, a suburb exterior of Lisbon. But they had been so upset by the strains of sufferers that they proposed opening a brand new well being middle to serve solely sufferers with no assigned physician.
The middle is in Seixal (pronounced say-SHAHL), simply throughout the Tagus River from Lisbon, the place practically 50,000 residents, a lot of them immigrants, haven’t any household physician.
The clinic takes its title, Via Verde Seixal, from a tool — invented in Portugal — that permits automobiles to pay tolls rapidly with out stopping. At the clinic, precedence sufferers bypass strains to get quick appointments. These are infants and youngsters as much as 2, pregnant ladies, folks needing immunizations, and people with acute issues comparable to trauma or urinary tract infections that want quick care. The workforce sees no less than 100 sufferers a day.
“Before folks can be ready in line at 3 a.m. We noticed pregnant ladies delivering with out ever having seen a health care provider,” Fernandes stated. In addition to serving immigrants, the clinic more and more sees long-time Portuguese residents as their docs retire they usually aren’t assigned new ones. “You need to be nearly lifeless to have precedence to have a household physician,” Fernandes stated.
The clinic operates on a shoestring finances. Fernandes and different docs take half the pay they’d make at a household well being unit. She depends closely on specialist nurses like Matos to offer care and employs residents, docs from different international locations ready to get their certification, and retired physicians. The docs actually take a again seat to nurses, working largely from a again room, consulting on complicated instances, offering prescriptions, and when wanted, popping out with their stethoscopes. (In Portugal, it’s solely docs which are allowed to take heed to the guts.) The clinic runs on donated computer systems, and Fernandes used cash she was awarded for an expert prize to buy tables and microwaves for the workers room.
But she is working in a model new constructing — that was constructed for a household well being unit that by no means opened due to the physician scarcity. “We had been completely satisfied as a result of we put the poorest sufferers in probably the most stunning of well being facilities,” she stated. “It’s very dignifying for folks.”
Fernandes is aware of what she’s doing isn’t sufficient. And she hopes the well being system can discover a method to educate and entice extra docs to work for the general public system so extra residents can get the appointments they want. “This is sort of a wartime mannequin,” she stated. “The happiest day shall be our extinction day.”
Some say it’s not honest to check well being metrics within the U.S. to Portugal, as a result of it’s a a lot smaller nation: It’s concerning the dimension of Maine with the inhabitants of Michigan. But that hasn’t stopped different international locations, and even some states within the U.S., from emulating its insurance policies, comparable to its strategy to reducing drug overdoses, which is taken into account a model for the world.
In the Nineties, Portugal had one of many highest rates of heroin use and fatal overdoses anyplace. In 2001, the nation not solely decriminalized the use and possession of medication, but in addition, in partnership with a number of non-governmental organizations comparable to Crescer, created a community of largely free inpatient and outpatient remedy facilities and cellular road groups that search out drug customers to offer medical care, clear needles, and assist to enter dependancy packages.
Two a long time later, drug overdose deaths have fallen sharply, from one per day (that’s numerous deaths for such a small nation) to about 70 to 80 per 12 months. New Jersey, with a smaller inhabitants than Portugal, sees 3,000 a 12 months. HIV an infection charges have dropped dramatically, too.
On a current day, a two-person road workforce from Crescer, current faculty graduates Mariana Gomes and Antonio Cabrita — clad in boots with three-inch-thick soles to forestall a stick from stepping on a discarded needle — set out throughout downtown Lisbon in a Fiat station wagon filled with contemporary water, cleansing wipes, and a nurse’s bag full of first assist provides. At Martim Moniz Square — which could possibly be a road in New Delhi with retailers promoting samosas and aromatic spices — folks emerged from doorways and walked as much as the workforce as quickly as they arrived, in search of new smoking pipes.
Those approaching had been a mixture of current immigrants and longtime residents. The workforce wished that they had pipes to distribute — smoking heroin is much less harmful than injecting it — however there was a scarcity. Instead, they handed out antiseptic wipes to maintain injection websites clean, water, and condoms as a part of a hurt discount technique. “You can’t simply have the legislation, you want the providers,” Gomes stated as she handed out clear squares of aluminum foil to make use of for smoking. “We attempt to begin the method to get folks to go to rehab. It can take as much as a 12 months.”
In an indication fewer folks had been injecting, nobody requested for syringe kits. The duo appeared for a pregnant girl they knew wanted medical consideration, however couldn’t discover her. They moved on to their subsequent cease, in a wooded space up a muddy path the place a person wanted look after persistent eczema and abscess wounds. He’d emailed them a horrifying photograph of his pores and skin — yellow, cracked, and bloodied — in order that they had been bringing medication.
“It’s so dangerous,” stated Gomes, clad in a blue vest coated with zippered pockets holding the instruments of her commerce comparable to hand sanitizer. “But he’s so disorganized, he can’t go to an appointment. Sometimes folks don’t even know what day it’s.”
The shoppers are clearly comfy with Gomes and Cabrita, most likely as a result of they see them practically each day. Coming commonly on the similar time is essential. Sometimes shoppers get somewhat too comfy, flirting incessantly with the younger social employees. “Taking successful is like an orgasm to my mind,” stated one, laughing, as he threw an arm round Cabrita, 26. “I inform them, ‘You’re older than my father, simply cease it,’” she stated, as she shrugged off his arm.
“I used to be nervous about working with this inhabitants,” stated Gomes, who took the place as her first job out of school. “But you do it as a result of it makes a distinction.”
And it does. “Our outcomes had been so spectacular, the drug phenomenon dropped from the primary political precedence to thirteenth or 14th,” stated João Goulão, who spent greater than a decade combating to place “the Portugal mannequin” in place after seeing the toll dependancy took on the sufferers in his common follow, and now serves because the nation’s drug czar.
Portugal’s success impressed the state of Oregon, the place voters embraced a measure to decriminalize medication in 2020, then unceremoniously dumped it earlier this 12 months after they deemed it wasn’t working.
That strategy was improper, stated Goulão. Oregon wasn’t affected person sufficient to see this system by, he stated, and didn’t be taught an important lesson that his nation provides: {that a} authorized change in drug coverage means little with out a robust, compassionate, and inexpensive public well being response. Portugal’s success, he stated, is inextricably linked to its nationwide well being system.
While the longevity here’s a reward for having well being system, it’s introduced new challenges: practically one in 4 Portuguese are over 65, and plenty of of them stay with severe persistent situations.
“Since 1979, folks right here stay 10 years longer, however these 10 years are incessantly lived with problem,” stated Manuel Lopes, who directs the nursing college on the University of Evora and sits on the board of the Comprehensive Health Research Center, a consortium of researchers growing new methods to raised ship well being care in Portugal.
Lopes has been advising Portuguese well being leaders to shift from considering of well being care as a largely medical concern to creating it simpler (and cheaper) for sufferers to get care from physiotherapists, speech therapists, psychologists, and different allied well being professionals for disabilities and psychological well being points that come up with age. “What they want usually are not extra appointments,” he stated. “They want a continuity of care.”
The nation’s well being service has recruited a wave of youthful leaders, together with 37-year-old Director General of Health Rita Sá Machado, to interchange an previous guard and modernize the system. Among the newcomers is André Peralta-Santos, the nation’s deputy director of public well being and a Lisbon-trained doctor, who earned a Ph.D. in world well being from the University of Washington, the place he targeted on knowledge science. Peralta-Santos helped optimize contact tracing in Seattle when the Covid-19 pandemic hit. The pandemic then introduced him residence to assist his nation handle.
He’s now making an attempt to use a lot of what he discovered within the U.S. — particularly the willingness to attempt unorthodox approaches and to make use of high-level knowledge science — to Portugal’s well being system. “The openness of American tradition actually amazes me, how open you’re to new concepts,” he stated. “It’s a tradition of not being afraid to attempt issues.”
Chief among the many challenges dealing with Peralta-Santos and his boss Sá Machado try to extend the effectivity of their well being system, grappling with the results of an ageing inhabitants, and taking up newer points like childhood weight problems. “We have numerous causes to be pleased with our progress over the past 50 years, however we even have numerous challenges,” he stated. “We are inclined to stay lengthy, however not in an awesome situation.”
This mission was funded partially by an International Health Study Fellowship from the Association of Health Care Journalists supported by the Commonwealth Fund. Our financial supporters usually are not concerned in any choices about our journalism.
