**Title**: ""**Keywords**:1. Portugal's Health System2. Primary Care in Portugal3. Public Health in Portugal4. Health Care in Portugal5. Portugal's Medical Success**Outline**:1. MRI Machine in Lisbon's Hospital2. Portugal's Health System Strategy3. Primary Health Care Clinics in Portugal4. Portugal's Success in Life Expectancy5. Challenges in Portugal's Health System6. Portugal's Covid Vaccination Success7. Private Hospitals in Portugal8. Drug Treatment in Portugal9. Aging Population and Health Care in Portugal**Introduction**:In the heart of Lisbon lies a public hospital that takes one on a journey through time. Amidst centuries-old tiles and Renaissance art, Portugal's health system stands as a testament to the power of focusing on primary care and public health. This article delves into the unique aspects of Portugal's healthcare model and its remarkable achievements.**Tagline**: "Discover how Portugal's health system defies expectations and offers valuable lessons for the world."**Article**:LISBON — Stepping into one of this city's largest public hospitals is like taking a trip through history. Plastic waiting room chairs coexist with centuries-old Azulejo tiles, and a nearby chapel shines with Renaissance statuary and paintings. Hospital de São José, with its ambulance bays, exam rooms, and labs, occupies a former college built by the Jesuits in 1579. This recycling of a timeworn campus exemplifies Portugal's health system. Instead of investing in new hospitals and expensive drug therapies, the country emphasizes primary care and public health.

Portugal's Health System Strategy

This strategy has served Portugal well. Despite spending only 20% of what the US does on healthcare per person, Portugal has a life expectancy nearly four years longer. According to the 2021 Global Security Index, it ranks third in providing access to affordable healthcare out of 195 countries, while the US ranks 183rd. Portugal's national health care system entitles every resident to free or very low-cost healthcare. "They take care of people. If you're poor, you still get health care. And you don't have to have a job to get health insurance," says Kyriakos S. Markides.

MRI Machine in Lisbon's Hospital

The radiology waiting room in Lisbon's centuries-old Hospital de São José is a sight to behold. It showcases the unique blend of old and new within the healthcare system. Ambulances enter the hospital, which was once a Jesuit college, adding to its historical significance.

Primary Health Care Clinics in Portugal

At the heart of Portugal's health success are primary health care clinics embedded in neighborhoods. These "family health units" work alongside regional public health units, with free data flow between them to track illnesses and unmet health needs. Gustavo Tato Borges, president of Portugal's National Association of Public Health Doctors, emphasizes the importance of this network.

Primary Care in Action

At the Baixa Family Health Unit in Lisbon's historic center, patients from various nations receive family care. Doctor Martino Gliozzi coordinates the center and follows patients from pregnancy to death. He implemented a system to distribute appointments throughout the day, reducing waiting times. For those unable to come to the clinic, doctors make house calls. The clinic also embraces "out of the box" ideas like Walk with a Doc to encourage exercise.

Portugal's Success in Life Expectancy

In 1950, Portugal's life expectancy was around 60, among the lowest for developed nations. But today, it has swapped places with the US, with an average life expectancy of 82.3 years. This remarkable progress is attributed to the country's focus on primary and preventive care.

Comparing with the US

While the US spends $4.5 trillion on healthcare per year and ranks around 60th in life expectancy among nations, Portugal achieves similar results with an annual healthcare expenditure of about $2,700 per person. "We are a sick nation," says Stephen Bezruchka. "The United States is the most innovative — and dysfunctional — health care system in the world."

Challenges in Portugal's Health System

Portugal is not without challenges. A shortage of primary care doctors leads to long waits for care, and over a million people, many of them immigrants, have no assigned physician. Despite the efforts of health care workers, the system still faces issues.

Doctor Shortage

The doctor shortage is partly due to demographics as those who started their careers at the dawn of the health system retire and are not replaced. Low pay in expensive regions like Lisbon and Nazaré also contributes to the problem. Many doctors and nurses leave for higher-paying Northern European countries.

Portugal's Covid Vaccination Success

During the Covid pandemic, Portugal's vaccination efforts were remarkable. Thanks to the country's decades-long focus on vaccination programs, vaccine hesitancy was minimal. Admiral Henrique Gouveia e Melo, a former submarine squadron commander, took charge and deployed military mathematicians to optimize vaccine delivery. He partnered with mayors and village leaders and used iconic soccer stadiums for mass vaccination sites. Portugal quickly became one of the world's most vaccinated countries.

Private Hospitals in Portugal

Some middle-class and wealthy Portuguese have turned to private hospitals for elective surgeries and other care. Private hospitals in Lisbon are often new and sleek, but they can feel impersonal. Some private providers are more interested in quick profits from simple procedures, leading insured patients to return to the public system.

Private vs Public Systems

This can lead to a vicious downward cycle, eroding the public system. "Across the region, private providers take the easy cases because they are there to make money," says Jon Cylus.

Drug Treatment in Portugal

In the 1990s, Portugal had one of the highest rates of heroin use and fatal overdoses. But in 2001, the country decriminalized drug use and possession and created a network of treatment centers. Today, drug overdose deaths have fallen sharply, and HIV infection rates have dropped dramatically.

Harm Reduction Strategy

Mariana Gomes and Antonio Cabrita from Crescer provide harm reduction services, outreach, and low-cost rehabilitation. They hand out antiseptic wipes and other supplies to prevent the spread of diseases. Their efforts have had a significant impact on reducing drug-related harm.

Aging Population and Health Care in Portugal

While Portugal's longevity is a reward for its good health system, it has brought new challenges. Nearly one in four Portuguese are over 65 and live with chronic conditions. Manuel Lopes advises health leaders to focus on allied health professionals for continuity of care.

New Leaders in Health Care

The nation has recruited younger leaders like Rita Sá Machado and André Peralta-Santos to modernize the system. Peralta-Santos, who learned from the US, is applying data science to improve the health system.In conclusion, Portugal's health system offers valuable lessons for the world. By focusing on primary care and public health, the country has achieved remarkable results in life expectancy and other health metrics. While it faces challenges, it continues to innovate and adapt to meet the needs of its aging population.