What is a local health unit?
It is an organizational model that integrates hospital centers, hospitals and health center groups into a geographic area. It’s not a new model. The first ULS was created in the last century, in 1999, in Matosinhos. After that, seven more emerged – Norte Alentejano (in 2007), Guarda, Baixo Alentejo, Alto Minho (all three in 2008), Castelo Branco (in 2010), Nordeste (in 2011) and Litoral Alentejano (in 2012 ). Together, these services serve about one million people.
From January 2024, the SNS Executive Board says there are conditions for the creation of another 31 ULS, bringing together all the hospitals and hospital centers of the country and covering almost the entire population of the continent. In total, the country will have 39 ULS, which are publicly traded entities. But the way this new wave of ULS is funded will be different from the current wave. Only the three oncology institutes (IPO in Lisbon, Porto and Coimbra) and the Cascais Hospital, the only hospital managed in a public-private partnership, were excluded.
What will change for people?
The NHS Executive Directorate ensures that the new ‘ULS 2.0’ model will improve access and reduce bureaucracy, streamlining the journey for users and patients within the NHS. It also believes that it will improve efficiency and enhance economies of scale, since ULS can avoid duplication and duplication of clinical procedures, specifies the entity led by Fernando Araujo. to NewspaperThe CEO said that ULS will have departments for patients with chronic diseases. He gave an example: In the case of a diabetic patient, a route is designated within the unit, which will prevent the patient from “pushing from side to side” to get to appointments, get tests and receive medication.
What will happen to the workers?
All employees in hospitals and health centers will transfer to ULS, regardless of their employment contract, even if they are on unpaid leave, without losing benefits and rights. The CEO of SNS emphasizes that the new model will be beneficial for workers, because it will facilitate the mobility of professionals, which are currently very long and complex processes.
How will they be financed?
The landscape of financing will change, and that starts with using a risk stratification tool that includes many more variables than today. The Secretary of State for Health, in an interview with PÚBLICO, explained that this risk stratification tool will make it possible to identify subgroups of people with similar needs – healthy, chronically ill, complex cases – and that ULS will be funded on the basis of this rather than being funded solely Through the number of jobs it provides, as is currently the case in hospitals.
Will the number of managers increase or decrease?
ULS’s boards can have up to six executive members, one more than stipulated in the SNS’s articles of association, which should be changed at this stage. According to the draft decree-law, in addition to the President of the ULS, the Board of Directors will have two clinical directors, a nurse director, a member proposed by the Ministry of Finance and a member proposed by the municipal community or metropolitan area, depending on the location of the ULS. Fernando Araujo believes that as of January 2024, the number of directors should neither increase nor decrease, and expects that a “significant portion” of the current directors of hospital centers and ACES will continue to lead the ULS.
Is ULS compliant?
No, the ULS Circular has been designated by the Executive Board as one of the largest regulatory reforms for the SNS since its inception. But the model was criticized by the Medical Syndicate and leaders of union structures representing doctors as well as by the National Association of Family Health Units, among others, who objected to the way the process was implemented and considered that it would be secondary to primary health care. They also recall that studies conducted to date, specifically the study conducted by the Health Regulatory Authority (ERS) in 2015, have not demonstrated an increase in the efficiency of the eight ULS systems already in place. The ERS concluded, for example, that there was no reduction in unnecessary hospitalizations and that guaranteed maximum response times were not being met. The Executive Board said observer That this study has “technical flaws” refers to a master’s thesis written by public health researcher Ricardo Alves, who says he found “gains in the perception of integration of care on the part of ULS staff.”
