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The provision of universal health care by the Portuguese NHS depends on the allocated government budget to health. Several reforms have been implemented over the last decades to improve access while ensuring the financial sustainability of the health care system. However, a practical and useable definition of public health sustainability is hard to find. We show that under two alternative definitions – both related to fiscal space and compliance with sound public finances – public health spending increase is limited. Our analysis indicates that public health spending growth levels below 3% can be financially sustainable.

Taking into account that financial sustainability is a function of economic growth and will depend on the level of control of other public spending, our forecast for long-run health spending growth is compatible with the financial sustainability targets defined.

The need to reduce health expenditures raises the discussion on rationing possibilities and there is a growing interest in considering society's perspectives. The aim of this paper was to evaluate Portuguese citizens' opinion regarding the imposition of limits on National Health Service (NHS) spending. We also asked who decides how NHS money is spent, in order to obtain the respondents' views on public involvement.

An online questionnaire was used to collect data. Descriptive and inferential statistics, factorial analysis and a logit model were applied.

Our results showed that most of the respondents believe citizens have low participation on NHS' financial decisions, confirming the lack of public involvement. Health professionals are more likely to agree with limits on NHS spending, which could indicate potential inefficiencies.

From a health policy perspective, we have concluded that different stakeholders should be involved before deciding how public spending limits should be implemented. Health professionals' perspectives should be considered, taking advantage of their experience.

The main novelty of this paper is the evaluation of whether there should be limits on NHS spending, comparing health professionals and non-health professionals.

This article aims to explore the gendered dimensions of the heterogeneous path of non‐native graduates in nursing and medicine in the Portuguese National Health Service, including institutional factors like the process of credential recognition, the professional integration and internal labour market segmentation.

Biographical interviews with nurses and physicians (23 males and 35 females) from Spain and from some Eastern European countries who migrated to work in Portugal were conducted, and additionally semi‐structured interviews with 12 institutional participants to contextualise the experiential data.

The research highlights complex intersections between gender and the resources for action. Institutional conditions, like legal frameworks and the self‐regulatory mechanisms of the professions, and individual characteristics shape successful translation of foreign credentials into a new social and cultural context. The specific configurations may create gender traps that push women into low status professional segments and also new forms of inequality in the professions.

The development of successful professional action and agency in a socio‐culturally different health care labour market can be differentiated by gender, place of graduation and citizenship status. The factors identified in this small‐scale qualitative study would need further investigation.

The findings highlight new demands for integration policies for foreign‐trained professionals, such as policies to promote equal opportunities for women and men in the workplace.

The article reinforces women as professional participants in the international migration process and examines the opportunities for successful integration.

The purpose of this paper is to explore the way gender may be used as an instrument to avoid New Public Management (NPM) potential processes of deprofessionalisation in nursing.

In total, 83 nurses with managerial duties were interviewed in autonomous and corporate public hospitals in Portugal.

Nurses used gender as an argument to legitimate their presence in management, and in this way, to keep their control over the profession. Gender stereotypes were used to legitimate their position in two different ways. Firstly, nurses reproduced and reinforced gendered inequality by supporting their male colleagues careers. Secondly, they valorised their feminine skills sustaining that women were in better position to manage hospitals as an extended role from the private domain.

The paper uses a sample from only one country and care must be taken when extrapolating conclusions to the wider population.

Acknowledges the way NPM reinforces gender stereotypes and contributes to redefine professionalism.

Recognition of the complexity and diversity of gender issues in the organisational context and in the structuration of professional legitimacy.

There is a growing interest in research focusing on performance management practices in the public sector, but research is still limited with regards to public primary healthcare services (PHSs), which play an important role in national healthcare systems. These organisations are frequently criticised for alleged poor performance management practices and misuse of resources, though such claims are not always substantiated. The purpose of this study is to examine performance management practices in public PHSs.

Three case studies of PHSs organisations were conducted resulting in interview material and archival data. Otley's performance management framework was used to examine the data.

It is found that the performance management systems of the studied PHSs were disjoint and lacked consistency and coherence. Lack of direction and motivational were key issues in PHSs. Furthermore, the observations indicate that vertical controls between PHSs and parent organisation were weak and accountability poor.

Generalisability of findings and social desirability bias are the important limitations. A key research implication is that the conceptual framework adopted can be meaningfully used to generate insights into performance management issues in public sector healthcare organisations.

The study highlights the implications of the poor design and use of performance management systems and highlights areas for improvement in the organisations studied, and potentially across the sector.

This study is the first to draw upon Otley's performance management framework to examine performance management practices in PHSs and to demonstrate its usefulness in this context.

The paper aims to study the influence of three dimensions of workplace spirituality (inner life, meaningful work and sense of community) on perceived and objective organizational performance in two primary health care settings: health centres (HCs) and family health units (FHUs), differing in terms of work organization.

Data on workplace spirituality and perceived organizational performance were collected from a sample of 266 health care workers (doctors, nurses and administrative staff). Data on objective performance were obtained from the respective regional health authorities. Multiple regression, GLM, and tests of mediation were carried out.

In both groups, perceived and objective organizational performance are predicted by sense of community. Additionally, FHUs presented significantly higher values in perceived and objective organizational performance, as well as sense of community and meaningful work. Finally, workplace spirituality and sense of community were found to mediate the relationship between work group and perceived and objective organizational performance.

The study's limitations include the convenience sample, as well as lack of control for the social desirability effect. Patient satisfaction surveys as well as the inclusion of predictive variables such as leadership should be considered in future studies.

Primary health care services, and particularly FHUs, revealed the importance of workplace spirituality. Work teams with higher sense of community had higher performance results, which may therefore be an input in policy decisions regarding primary health care.

This study compared the scores of workplace spirituality and perceived and objective organizational performance in two types of primary health care services, in a setting that approximates the quasi-field experiment. Workplace spirituality emerged as significantly mediating the relationship between work unit type and organizational performance.

The purpose is to assess the impact of clinical costing approaches on the quality of cost information in seven countries (Denmark, England, France, Germany, Ireland, the Netherlands and Portugal).

Costing practices in seven countries were analysed via questionnaires, interviews and relevant published material.

Although clinical costing is intended to support a similar range of purposes, countries display considerable diversity in their approaches to costing in terms of the level of detail contained in regulatory guidance and the percentage of providers subject to such guidance for tariff setting. Guidance in all countries involves a mix of costing methods.

The authors propose a two-dimensional Materiality and Quality Score (2D MAQS) of costing systems that can support the complex trade-offs in managing the quality of cost information at both policy and provider level, and between financial and clinical concerns.

The authors explore the trade-offs between different dimensions of the quality (accuracy, decision relevance and standardization) and the cost of collecting and analysing cost information for disparate purposes.

Continuous introduction of advanced health technologies coupled with limited resources force governments to adopt rationing measures in all types of health systems. The mass media can influence the application of these measures by rising people and patients' expectations and demands for new forms of healing. This article intends to find evidence of this influence by reporting two recent cases which occurred in Portugal involving two innovative drugs, one for the treatment of hepatitis C and another for type I spinal muscular atrophy. The new drugs were not publicly funded despite promising excellent overall health outcomes because of their high cost and exaggerated burden on national health system (NHS).

A qualitative research was used to collect information conveyed by the conventional media and social networks.

After a strong dissemination through conventional and social media of the nonapproved treatments, the drugs swiftly garnered support among the public and triggered remarkable and relentless advocacy efforts. The findings of this paper suggest that society opinions and, by extension, the decision of policy-makers are very susceptible to the influence of the mass media.

New ways of sharing information are changing health research and public health.

These stories raise complex tensions and important questions about resource-allocation decisions involving scientific research or innovative medicine. Societal preferences seem very vulnerable to information conveyed by the mass media.

This study is the first attempt to awaken attention to the influence that Portuguese mass media may exercise on future healthcare rationing decisions.

The purpose of this paper is to compare user involvement in the case of assisted reproductive technologies in England and Portugal through the concepts of voice, choice and co-production, assessing the implications for user empowerment.

This qualitative study draws primarily on policy review and uses exploratory semi-structured interviews with key informants as a way of illustrating points. Data on the following themes was compared: voice (users’ representativeness on licensing bodies and channels of communication between users and doctors); choice (funding and accessibility criteria; choice of fertility centres, doctors and level of care); and co-production (criteria through which users actively engage with health professionals in planning the treatment).

Inter- and intra-healthcare systems variations between the two countries on choice and co-production were identified. Differences between funding and accessibility, regions, public and private sectors and attitudes towards doctor-patient relationship (paternalistic/partnership) were the key issues. Although consumer choice and indicators of co-production are evident in treatment pathways in both countries, user empowerment is not. This is limited by inequalities in accessibility criteria, dependence on doctors’ individual perspectives and lack of genuine and formal hearing of citizens’ voice.

Enhancing users’ involvement claims for individual and organizational cultures reflecting user-centred values. Effective ways to incorporate users’ knowledge in shared decision making and co-design are needed to empower patients and to improve the delivery of care.