Health governance in a context of crisis - the perspective of efficiency and effectiveness in the Portuguese health system

The financial and economic crisis from 2008 has a great impact in welfare states, notably in one of their fundamental pillars – health. In Portugal, the total spending on health reached 10.1% of GDP in 2008 and will increase in view of the current panorama. The objective of this study is to analyze the health policies and the Portuguese health system, in a context of economic, financial and social crisis, in the light of the speeches of policy-makers and experts about the processes of governance and contingency measures, considering dimensions of analysis efficiency and effectiveness. In the dimension of effectiveness, measures have been pointed out for protecting the most vulnerable, for the empowerment of citizens, for reduction of inequalities and for the protection and promotion of health. Finally, in the dimension of efficiency, there are important measures to cut off expenditure, of mobilization of financial resources, in the rationalization of resources and services and in professional and organizational development. In theoretical domains of risk and uncertainty, we see through the speeches of policy-makers and experts, that these are domains for the exercise of policies on critical governance processes, determined by identified sources of insecurity, processes of public debate and in terms of policy dispute.