Week after week, a conviction that I have formed over the last three decades is reinforced: the SNS was gradually captured by corporate and business interests, becoming the stage for what I consider to be the biggest looting ever committed against the Social State and public money.
The first sign of this “open bar” in healthcare came to me in the 90s, when I was comparing the professional paths of young graduates from various areas. In professions such as teaching, engineering, architecture, management and many others, there was continuous and encouraging growth. The social elevator was working, prosperity seemed to be democratized and young people were finally beginning to be able to buy an apartment, a simple car, and provide their children with decent study conditions. They were, indeed, good times.
But there was a notable exception: medical graduates. If at school we were colleagues following parallel paths, in adult life it became evident that they didn’t use the elevator – they got directly into a rocket. Within a few years of their career, they were already driving Mercedes or jeeps, building houses and dressing their children in the most expensive brands.
Intrigued, I started connecting the dots. I realized right away that the medical corporation was extremely effective at limiting competition. Medical courses only existed in Lisbon, Porto and Coimbra, and any attempt to expand the offer was immediately stopped by the Medical Association. The basic logic of the market worked: the less supply and the more controlled, the higher the value.
Then what I call looting industries emerged: fraudulent sick leave, medical boards that facilitated early retirement, selective prescriptions of medicines that guaranteed paradisiacal trips offered by pharmaceutical companies. These and other practices ensured large monthly incomes, always at the expense of the public treasury.
But the worst was yet to come. The aggressive entry of the private sector activated a powerful communication machine dedicated to discrediting public health, diverting users to its structures. Doctors and nurses followed the money trail, accumulating roles in various locations, which caused absenteeism in the public sector to skyrocket to scandalous levels.
And, even within the SNS, the looting continued unabated: highly profitable additional surgeries, the proliferation of regular doctors, the fraudulent registration of immigrant users in the system, or the prescription of antidiabetic drugs used to lose weight. The list seems inexhaustible.
This “open bar” scenario that is slowly being revealed may just be the surface of the problem. With so much fraud accumulated, I fear that the time will come when the health budget tap will inevitably have to be turned off.
Professor