The Portuguese healthcare system is often portrayed as a National Health Se
rvice (NHS) model, characterized by universal coverage, comprehensive benef
its, nearly free services, national tax financing, and public ownership or
control of the factors of production. However, in reality the system fails
to accomplish these features in a complete way. There coexist a number of o
ccupation-related health insurance schemes that were originally intended to
be integrated into the NHS. in addition, in key areas the NHS does not pro
vide the wide range of services it promises. The public sector has a predom
inant role in the provision of hospital stays and general practitioner cons
ultations, but the private sector provides a major portion of specialist co
nsultations, dental consultations, and diagnostic services. Major problems
in the system led to health reforms in the 1990s. New reform proposals incl
ude some specific steps concerning health technology, including standards f
or medical equipment based on quality, geographic distribution, sustainabil
ity, and cost-effectiveness. A new National Plan of Health Equipment was co
mpleted in 1998, aimed at improving the distribution of equipment Despite r
eforms, healthcare expenditures continue to rise. There is general agreemen
t that gains in efficiency could be made. This situation is beginning to en
courage interest in health technology assessment (HTA) in Portugal, althoug
h these activities are not yet very developed. Recently, legislation requir
ing presentation of economic evaluations for new pharmaceutical products wa
s enacted. Present plans also call for the creation in the future of a nati
onal agency for HTA.