In statements to the Lusa agency, Frederico Guanais also pointed out the need for "greater dialogue between Finance and Health": "Health always thinks it does not have enough resources and Finance thinks that health is like a bottomless pit. A way must be found".

The official, who came to Portugal to participate in a conference on the sustainability of health systems promoted by the Council for Health Prevention and Well-being of the Portuguese Business Confederation (CIP), acknowledged that this is not a challenge exclusive to Portugal, but rather to all OECD countries.

Deputy Director of the OECD Health Division, Francisco Guanais recalled that, during the pandemic, the health sector received additional resources "in a considerable way", because it was necessary, giving the example that, in Portugal, in 2021, expenses in this area increased by 10%, while the GDP in the previous year had fallen by 8.4%.

"We have a problem here", he said, recalling that, after this increase during the pandemic, there was "a strong correction" and expenses "practically did not change in 2022".

Pointing out that the OECD is still waiting for the data for 2023, the specialist said that the essential thing is to define the path to be taken: "Are we going to experience another period of austerity? Or will the countries understand that a health crisis costs a lot and that it is important to invest intelligently to prevent problems in the future?".

Regarding Portugal, he recalled that the population has a high life expectancy, however, in old age, they have "low quality of life". "A Portuguese woman can expect to live 22 more years. However, of those 22 years, only seven will be lived in good health. The other 15 in poor health", he exemplified.

He recalled that these last 15 years "cost the health system a lot" to underline the importance of a strong commitment to prevention: "healthy ageing is essential so that the health sector's accounts can be balanced".

"This does not only happen when you reach 65 years of age. It already happens before, investing in prevention in a broad way (...), in prevention programs and public health policies in the areas of food, alcohol or tobacco", said the specialist, recalling the low national investment in prevention (3% of the health budget at the time of the pandemic) compared to the 5% of the OECD average, which he also considers weak.

"It is this strong commitment to prevention that will allow the population to age in a healthy way, so that the demand for health services is more reasonable", he said, insisting: "This is a fundamental point for the crossroads at which Portugal finds itself - to reorient its health system towards a greater emphasis on prevention".

Frederico Guanais also considered that "any investment and expenses in health occur from a dialogue between the Ministries of Finance and Health for structuring budgets and health programs" and calls for "stronger coordination" between the two areas, with a multi-annual health budget.

"It is necessary to understand what the budget objectives are, what the objectives of each [health] program are and to be aligned with the country's public health objectives", he said.

The OECD official also stressed that, of Portugal's health expenditure in relation to GDP, 29% is direct expenditure by families ('out-of-pocket'), a value "much higher" than the OECD average, which is around 18%. If we include insurance expenses in this value, in the Portuguese case it reaches 29%.

"This is a problem because these expenses are incurred in a way that is not always the most efficient", he warned.

He considered that the health sector in Portugal can play a role, but warned: "the duplication of systems can generate additional administrative expenses, it can generate inefficiencies".

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