​Press release 05/2021

 

 

The AdC has proposed recommendations to the Portuguese Government, aimed at removing unnecessary barriers to the opening of new centers and at promoting patient choice, after receiving contributions from the National Health Regulator (Entidade Reguladora da Saúde – ERS) and stakeholders in a public consultation on the preliminary version of the report. These recommendations are necessary to ensure patients have better access to hemodialysis treatments.

 

Over 12 000 people in Portugal undergo hemodialysis treatments, three to four times a week, mostly at private centers contracted  by the National Health System
(NHS).

 

According to information provided by the sector regulator (ERS), in several regions of Portugal, each treatment requires a round trip lasting, on average, more than one hour, given the low number of centers in these regions.

 

For each treatment, chronic patients must travel between their home and the hemodialysis center. Travel time is a significant factor in the quality of life of patients, given the frequency of treatments and the typical patient profile. For this reason, location is one key variable in the competition between centers.

 

In this context, the AdC restates the importance of removing unnecessary barriers to the opening of new centers, namely related to delays when contracting with the NHS and the legal uncertainty for operators, so as to increase the proximity of centers to chronic kidney disease patients.

 

The quality of hemodialysis care, understood in a wide sense, is also an important dimension of competition, with a significant impact on patients’ well-being.

 

In regions with a greater density of centers and a shorter round trip duration, several centers may qualify for free patient transportation by the NHS. In such cases, existing mechanisms may be harnessed to increase patient choice regarding the centers where they are treated, intensifying competition for quality between centers. The AdC, therefore, recommends a duty to inform patients in such cases.

 

In addition, the AdC recommends the creation of a system of quality indicators to compare centers, so that patients and health professionals may make better informed decisions.

 

The recommendations by the AdC are put forward in the context of the existing legal framework for dialysis care provision in Portugal, and aims at taking advantage of existing degrees of freedom to promote the conditions for competition in the market.

 

The AdC had submitted the preliminary version of the report to public consultation in November 2020. Contributions received from stakeholders, as well as the sector regulator’s opinion have allowed to strengthen the concerns raised by the AdC. The report on the public consultation is also made available.

 

 

 

1| Publish the standard contract clauses for the hemodialysis sector, overdue since 2013.

 

2| In the standard contract clauses:

 

  (a) assess the possibility of granting a contract by tacit approval; or, if not possible, assess alternative mechanisms to increase legal certainty for private operators; and

 

  (b) introduce a deadline to respond to contract requests.

 

3| Remove unnecessary obstacles that prevent entry of operators and/or the opening of centers because of the existing capacity, the concentration in the market, or the use of existing resources.

 

4| Create a unique portal or form that, from the point of view of the operators, link both the licensing and the contract procedures required by the NHS.

 

5| Ensure that the quality requirements indicated by best practice guidelines for hemodialysis are technologically neutral.

 

 

6| In the non-emergency patient transport regulations:

 

  a) Introduce a duty for the Regional Health Administrations (ARS) to inform the patients when several facilities meet the NHS transportation criteria; e

  b) Develop a cost-benefit analysis on the possibility of introducing a reimbursement option for patients who ensure their own transport, limited to a certain reference value.

 

7| Create a system of indicators based on quality so as to facilitate comparison between hemodialysis centers.