Draft law number 154/IX
Discussion in the Assembly of the Republic
22 February 2006
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Mr. President: - We will begin the debate in general, the draft law paragraphs 86 / X - Direct the integration of dentistry in the National Health Service and the career of medical dentistry (BE) and 195 / X - Inclusion of medical dental careers of senior technicians in health (CDS-PP). For an intervention, has the floor to Ms. Mrs. Ana Drago.
Ana Drago (BE): - Mr. President, Honorable Members: We know that oral health status of the population is worrying. The World Health Organization has noted Portugal as one of the worst countries in the European Union in terms of access to care and treatment of oral health. Successive surveys and statistics have shown alarming numbers.
About 60% of Portuguese citizens have no access to care or treatment within the oral health by strictly economic reasons. That is, your family budget does not allow them to access treatment, over 70% of public hospitals in Portugal, did not provide access to doctors and dentists so is 90% of health centers. Moreover, a latest survey done by the Order of Physicians Dental, we know that only one health center, of the 340 available, that provides its users, their area of residence, a part of the emergency dentistry.
So this is the situation we have. The experts who know the situation and have reflected on these matters say that the situation of the population is dramatic - the word is theirs, I believe was used by the president of the Association of Physicians Dentists - and access to treatment within the health oral is generally defined as a luxury. Not only the experts say that any person on the street, you can say the same to one of the Honorable Members.
However, this situation of deep social inequality in access to health care that are essential and this situation of profound lack of population are the result of the policy that has been followed in terms of oral health in the last 25 years within the structure of National Health Service can even say that the profound social inequality and lack of population are the result of a policy of contracting with private and with very low contributions from the National Health Service, which shows the true failure of this kind of guidance policy.
It is true that when it started to build up the National Health Service in Portugal in 1979, this was a difficult process of construction, enlargement, which sought to improve the health of the general population and, therefore, had flaws. It was in this exact sense, to fill those gaps, which admitted the idea of contracting with private to allow access to some care to public health services could not provide, at a time when the structure was still the Service National Health. Today, this is a strange equation: continue with a population clearly needs in regard to treatment care and prevention in the context of oral health and, however, we have a large number and more than enough of doctors trained dentists in fact a formation that can be understood as a reference in the European Union, since it is an elongated training of 6 years. This House has to decide - the Socialist Party in particular - and make some choices regarding central to this. First, the Board - the Socialist Party and other Honorable Members - must decide whether the oral health is a central element of the overall health of individuals and Portuguese citizens and is therefore a priority of the Government of Socialist Party. Secondly, if the answer to the first question is positive, if they consider that, of course, this is a central element in the Portuguese health, then you decide what is the political path to choose: to integrate dentistry within the Office of National health or continue a policy that has been disastrous in terms of the levels and quality of life of the Portuguese, a policy of contracting with private, which is hardly understandable, because all the specialties that we tend to be integrated into the SNS (they serve the same reference to practices that are in private), and we always believe that is the SNS that should provide the best health care to the population. I wonder if the Government of the Socialist Party, however, perhaps more open to interpreting the words of the Minister of Health issued the previous Friday, believes that all specialties can be provided to contract with the Portuguese private and therefore quite simply, wants disarticulate is destroyed the building which was the National Health Service in the last 25 years. The choice of the Left Bloc is very clear: we believe that we must integrate into the SNS dentist, a career structure, make this thread in this Assembly, creating perhaps a working group that allows members of the joint Committees on Labor and Health, calling people who are working on this. We know that the structure of a medical career is always a complex process. We are prepared to do so, it is essential to integrate tables of the public health dentists and doctors so that in three years, we can truly meet our responsibilities, ie ensuring that all citizens have access to health care the base - we are not talking about the cosmetic treatments, but a core of health problems -, ...
Voices of the BE: - Exactly!
Ana Drago (BE): - ... and to policies for the most needy: the elderly, drug addicts and prisoners. It is as simple as that! This is what the Left Block Assembly proposes that, because only then will have decent levels of oral health in Portugal and only then will a truly democratic politics of access to health.
Applause from BE.
Mr. President:- To ask for clarification, is the word you Marisa Costa.
Marisa Costa (PS): - Mr. President, the Socialist Party considers the debate on the oral health of the utmost importance. Therefore we believe that this should form part of the ongoing process of reorganization of the general functional teams involved in the community, as in the Document of the Technical Group for the Reform of Primary Care, 15 July 2005, which provides, among other measures: "Include in the process of reconfiguration of health centers, from its inception, the organization of multi-functional teams responsible for programs and projects of intervention in the community (eg, continuing care and palliative, with projects strong component of social-psychological support, health education, oral health, occupational health (...) among others. We therefore believe the account is convenient, timely and appropriate to establish a career as a dentist in the current context of restructuring health services.
Moreover, the Socialist Party and has been defending champion of the National Health Service, by the way here proposed by Block Left raises some questions for which we would like to get answers. Determined and quantified the Left Bloc of the costs of implementing the proposals contained in the draft law presented today, namely the integration of dentistry in all institutions of the SNS, the creation of the career of the dentist and contributions of the beneficiaries of the SNS in accordance with the table of ADSE?
Voices of the PS: - Very good!
Marisa Costa (PS): - If so, consider the block Left as the costs of implementing these proposals are affordable within the existing budget for health, and suggests areas in which the left block that make cuts to make the proposals today presents?
Applause from the PS.
Mr. President: - To respond, the floor to Ana Drago.
Ana Drago (BE): - Mr President, on the question of costs, let me give you some numbers that will probably help to clarify a little the debate.
The DECO did a study and an extended investigation, asking that the Portuguese were the costs that, in general, spending on access to oral health care in these 98% of private clinics that exist in Portugal, and consulted the private clinics, trying to understand exactly how much access to a family under the care of oral health. Let me tell you some figures that, on average, are paid in dental clinics: A checkup costs between € 42 and € 55, a filling between 51 € and 70 €; the extraction of a tooth between € 44 and € 62; devitalization a cost € 150, a prosthesis or toothing between 483 € and 717 €. These are the costs for the Portuguese.
She has to answer the question you raised, or you do not see oral health as a central element of the overall health of the individual and therefore does not consider it a priority. Think therefore that a long-term investment that can provide the National Health Service (SNS) human resources we have, and well trained, and equipment to be purchased and can be profitable over time should be abandoned in favor of a policy for contracts with private or, for example, the benefit of a policy in which, quite simply, any oral health care is provided to the Portuguese? I seen it?
Helena Terra (PS): - Answer to question you!
Ana Drago (BE):- You said that this is not the time for which we propose, should be made cuts in other sectors. Let me remind you, however, that a controller of the Socialist Party, for more government, said that today in a career in dentistry is not integrated in the National Health Service is due to the fact that 'there is financial pressure and never consider the oral health a high priority. He also said that the governor, in a relaxed tone, according to the news, have all the willingness to proceed with the dental health services in the main central hospitals in the country. These statements were made by the Minister Correia de Campos.
Helena Terra (PS): - When?
Ana Drago (BE): - On 28 November 2005! Ask for the services you deliver a photocopy. As such, or the Minister Correia de Campos says this is not feasible with what will occur in the context of health policy of the Government or the Parliamentary Group of the Socialist Party has a position differs from the government. Another possibility is that everything is the same, as' waters of cod. "What is essential is to realize you have to consider oral health as a priority or not, ...
Helena Terra (PS): - I said, lady!
Ana Drago (BE): - ... because the National Health Plan considers it as such. Is there a way of written agreement, saying it is the following: "shall be open to the medical staff of the dental hospitals of the National Health" is the point, which is on page number 81 of the National Health Plan, which remains meet, and is just what the Left Block is today proposing to the House.
What is essential is that the Socialist Party takes its responsibilities to the Portuguese and say that if they want to have oral health, continue to pay the prices that private clinics listed, although the Portuguese public universities train physicians and dentists although the service National Health include this area of medicine in their skills.
It is a fact that health is expensive, but the presentation of solutions is our responsibility. The Portuguese contribution to the National Health Service paying their taxes, and pay your pocket what is your right!
Applause from BE.
Helena Earth (PS): - And the answer to, lady?
Mr. President: - In a speech, the floor you Teresa Caeiro.
Teresa Caeiro (CDS-PP): - Mr President, in presenting the draft law under discussion, the CDS-PP had in mind three realities within which outlined the proposal. First, the worrying situation of oral health in Portugal, that is, as we all know, among the worst of the European Union regarding access to this type of care. Moreover, also had in mind as important instruments as the recommendations of the World Health Organization and the Law on Health, which determine the duty of the state in promoting and securing the access of all citizens to health care, including oral health. Just a year, in January 2005, even during the coalition government of PSD / CDS-PP, was approved and presented the National Program for Promotion of Oral Health, which was a significant step in addressing this issue, making it a priority and showing sensitivity to the tutelage of then on this serious flaw.
Voices of the CDS-PP: - Well remembered!
Teresa Caeiro (CDS-PP): - On the other hand, had in mind a study conducted by the Order of Doctors Dentists in November 2005 - very recently, so - which concluded that 72% of hospitals and 93% of health centers do not provide this service users. This absence is dramatic, first by the lack of health care provided and, moreover, creates a great social injustice by ensuring that people with fewer resources are prevented from having this type of care.
But there is more, since there is a clear degradation in relation to numbers four years ago. The explanation for the decline in SNS provision for oral health care leads us to the second reality which is our project, ie the emptying of stomatologists that has been observed in the National Health Following the closure this specialty in the course of medicine, the number of stomatologists has, naturally and progressively, the decrease in hospitals and health centers, which soon regret that the law has no adequate provision for its replacement in the tables of public health services. Indeed, six years after the creation of this degree, the dentist can only perform their duties as professionals, since there is no legislation that includes the SNS, nor is there a suitable conventional system, under which provide care "for 'the SNS. Incidentally, this problem was detected and included in the National Health Plan currently in force and not amended or repealed by the Socialist government. The third reality is that our project is that the CDS be sensitive to the economic reality of the country and the need for rationalization and containment of public spending, which, alongside the restructuring of public administration, advise caution and sparingly in the creation of new independent careers.
Nuno Magalhães (CDS-PP): - Exactly!
Teresa Caeiro (CDS-PP): - It was, therefore, given the urgent need to equip the SNS of doctors dentists but also taking into account the financial situation of the State, that the CDS-PP balises this. Therefore, our draft law aims at the integration of dental medicine in the National Health Service through the inclusion of dentists in a medical career already, which is the health of senior technicians. From the practical point of view, this route has the same value and the same effects that the creation of an independent career, with the difference that the remuneration and conditions will not be different for other professions that already incorporate the development of superior technical health.
Voices of the CDS-PP: - Very good!
Teresa Caeiro (CDS-PP): - Indeed, the career of the senior technicians of health, enshrined in Decree-Law No 414/91 of 22 October, was created taking into account the specificity involving the professions originally covered, highlighting the differentiation and qualification of its professional classes. Furthermore, in the case of doctors dentists, and the high degree of specialization, and EU standards, leave no room for doubt about the specialty of this branch of health. Thus, we shall be defining the content of functional and comprehensive manner appropriate to their professional profile, which includes the acts of doctors, of course, and technical documents. It seems clear the urgent need as an alternative to more costly process of creating a career itself, include dental under the careers of senior technicians in health, the statutory scheme expressly provides for the possibility of including other branches of the beyond the originally envisaged.
This solution, as I said, is, first, the reason for users to ensure the care and treatment needed for a population with an enormous amount of people wholly or partially edentulous and, moreover, has the virtue of allowing a greater flexibility, or the authority or the government and direction of hospitals and health centers in the filling of posts, depending on their funds available does not represent, therefore, any burden. We stress the latter because, as the CDS-PP a party institutional and responsible, is aware of the economic constraints the country faces.
Nuno Magalhães (CDS-PP): - Exactly!
Teresa Caeiro (CDS-PP): - We, in any case, two notes. Firstly, to say that this solution should be temporary until the political and financial situation of Portugal allows the creation of a career and very independent. Secondly, to emphasize that the entry of doctors dentists in the National Health Service, while technical colleges of health, can not, for the organization of services and distribution of responsibilities, creating a logic of subordination in relation to professional careers with autonomous already created.
Any tension arising from issues of hierarchy will be profoundly negative for the proper functioning of these services and the provision of oral health care. It, therefore, ensure that there is overlap and to be seen obvious functional differences, it is delimiting the areas of intervention of doctors and dentists stomatologists still in office, on the one hand, and the intervention areas of the maxillofacial surgeons on the other. The prosthesis, pathology, TMJ, endodontics to the Periodontics and diagnosis cancer are clear, specific areas of competence of doctors dentists.
Applause from the CDS-PP.
Mr. President: - To seek clarification, is the word you Marisa Costa.
Marisa Costa (PS): - President, ladies and gentlemen, Teresa Caeiro, is well understood by draft law is discussed herein, refers to the Parliamentary Group of the CDS-PP promote the integration of dentistry within the National Service Health through the inclusion of dentists in the medical career of senior technicians of health. Allow me then to read a short excerpt from the speech of Isabel Gonçalves, of the Parliamentary Group of the CDS-PP, when discussing the draft law presented by the Left Bloc in the previous Legislature, specifically on 6 February 2003, aimed at integration of dentistry in the National Health Service through the inclusion of the classification of medical and technical colleges of dental health. I will read:
"(...) We would have dermatologists, pulmonologists or ophthalmologists in health centers, health centers, turning the real into polyclinics with all the specialties of the service users, but unfortunately the financial situation of the National Health Service not allows the government to actually implement this ...!"
Fatima Pimenta (PS): - Well remembered!
Marisa Costa (PS): - Go ahead and continue Isabel Gonçalves, of the Parliamentary Group of the CDS-PP, saying that: 'We do not think (...) the creation of a more technical career in the upper right answer to this problem. It would probably be the easiest and most popular, but it would be one that would contribute to a further worsening financial, an increase of expenditure for the National Health Service.
Voices of the PS - Well remembered!
Marisa Costa (PS): - The first thing you should ask, first, the Parliamentary Group of the CDS-PP, is what has changed in three years here, in addition to worsening financial conditions in which your government has left this country.
Voices of the PS: - Very good!
Marisa Costa (PS): - Furthermore, it is illogical and contradictory to propose the introduction of another branch in the current development of technical colleges of health, thereby enhancing the career system of government, when called and always maintain the weight loss of the state?
Applause from the PS. Mr. President: - To respond in half a minute, has the floor Teresa Caeiro.
Teresa Caeiro (CDS-PP): - Be synthetic, lady, thank you for reading a speech he made earlier by a Member of the bench. But, not wasting time, ask it to also read the speech which the Socialist Party produced at the time.
Nuno Magalhães (CDS-PP): - Exactly!
Voices of the PS: - We read!
Teresa Caeiro (CDS-PP): - In response to your question very directly, is that what has changed since then was a mass exit of stomatologists, leaving positions unfilled in hospitals and health centers. The statistical data exist and you have to look, but it does not find, I am more happy to get them. In any case, now you say that these data confirm that, as I said earlier, 72% of hospitals and 93% of health centers do not provide this type of care, which, apparently, the Socialist Party does not consider fundamental or priority for the ordinary citizen.
Helena Terra (PS): - Nobody said it!
Teresa Caeiro (CDS-PP): - You believe with certainty that those who can pay hundreds of euros for access to such care, it does so, using the private sector, where these doctors work as dental professionals, and that those who have no income for it, is without teeth, which is what happens to much of the population!
Applause from the CDS-PP.
Helena Terra (PS): - This is demagoguery. We have priorities!
Teresa Caeiro (CDS-PP): - I spoke to me about the hypothetical expenses that the massive adoption of our project would, madam, but you would have to read your request for clarification and therefore do not hear me! Anyway, I repeat that we led, contrary to what was left of the block, not to submit a draft law to advocate the creation of an independent career was exactly the concern about the financial situation.
Nuno Magalhães (CDS-PP): - Exactly!
Teresa Caeiro (CDS-PP): - As you know, there is a difference between creating an independent career in the civil service, with their bands, and broaden the scope of an existing career, which in this case is the technical colleges of health.
Nuno Teixeira de Melo (CDS-PP) - This thread is different from the discussion of three years ago!
Teresa Caeiro (CDS-PP): - Besides, you know perfectly well that the measure we propose does not require the massive costs that you mentioned.
Applause from the CDS-PP.
Helena Terra (PS): - And or not increasing the number of public officials?
Mr. President: - In a speech, the floor you Carlos Miranda.
Carlos Andrade Miranda (PSD): - President, the English national health service has been recruiting doctors dentists Portuguese. However, for now, the uncontrolled growth of dental graduates in the seven Portuguese universities will, immediately and inevitably, unemployment and accelerate the migration. Meanwhile, Portugal is holding the worst rates of oral health in the European Union. All this because the State in Portugal, not into dental services for hospitals and health centers. So, do not guarantee the right to health nor to use the excellent resources available.
Voices of the PSD: - Very good!
Carlos Andrade Miranda (PSD): - President, aware that oral diseases are by their high prevalence, one of the main health problems of children and youth, the XVI Constitutional Government, by order of the Minister of Health, 5 January 2005, approved the National Program for Promotion of Oral Health, for practitioners and facilities of the National Health Service is, or is it is the program for more advanced oral health that has ever been gizou this country, developing a comprehensive strategy of intervention, aimed at health promotion and prevention of oral disease throughout life.
Fatima Pimenta (PS) - This program was created by PS!
Carlos Andrade Miranda (PSD) - Like many things of quality that were done in this country, particularly in health, this program has been neglected by the arrival of the Socialist Party to power in March 2005.
Voices of the PSD: - Very good!
Carlos Andrade Miranda (PSD): - It is for this Assembly, in exercising its supervisory activities, call for the Government in this area, implementing the program of urgent oral health outlined before. Consider, however, the proposals involved. Block the Left part of a correct diagnosis, but prescribed a wrong solution. It left in the block that the state reverse the current situation, through the massive absorption of doctors dentists in the tables of the National Health Service, however, when the National Health Service is on the threshold of sustainability and historical moment in which the Minister of Health, almost in despair of cause, already calls for payments of services, propose such a measure is in practice to comply with the perpetuation of inaction.
But the Left Block is not limited to demand the impossible. Goes with other proposals, such, but for practicality as possible. Let me highlight three examples. First, you have to do with the review of the contribution of the State in the price of treatments for oral health, it is achievable! Another is related to the tax cost of these treatments. And finally, finally, is to encourage the participation of municipalities in the task of national promotion and prevention of oral health.
Indeed, in the latter case, given the failure of the regional health administrations, which do not continue with the recruitment of medical and dental services despite the availability of sufficient financial means, some municipalities Portuguese took over the promotion of oral health in their counties. It was the textbook example of the city of Mangualde that, during 2005, concluded a protocol with the Portuguese Association of Oral Health and School of Dental Medicine at the Catholic University in Viseu, following which all students of the 1st cycle of basic education the county of Mangualde were observed and the cost of these consultations was supported by the municipality and not the regional administration of health.
This example can multiply, since the Ministry of Health enforces the solutions that are already planned. Do not doubt is that time of the state assume its responsibilities in oral health here. Hospitals and health centers should promote the immediate selection of partners with whom doctors dentists have to hire both in the form of contract for services such as public-private partnership, or opening of access to medical units of dentists family health, which seems to them for the time being prohibited.
Regina Ramos Bastos (PSD) - Very good!
Carlos Andrade Miranda (PSD) - It, therefore, the state of a wide range of contractual models available to them, without having to turn the doctors dentists in public officials.
Applause from the PSD.
Mr. President: - In a speech, the floor you Fatima Pimenta.
Fatima Pimenta (PS): - President, the National Health Service is part of the heritage we have built with our democracy. In 32 years, ensured health care for millions of citizens. The National Health Service has, therefore, a requirement of the Portuguese people. The health indicators in Portugal, contribute today, so relevant, so we can compare with pride most of the indices commonly used in assessing the stage of development of peoples.
All agree in this House that in this area, we have nothing to fear in comparison with some developed countries themselves, for example, the U.S. and England, where, in health, there are large sections of the population without any medical assistance.
Voices of the PS - Well remembered!
Fatima Pimenta (PS): - We discussed today in this House, the projects of the groups of the Left Bloc and the CDS-PP. The signatories claim that within the National Health Service is incorporating a new professional: the dentist. Do not question the nobility of its aims. However, they are more noble, if not take care to examine their effects, put at risk the entire National Health Service.
All believe that the provision of care in oral health should be part of the general health of citizens.
Voices of the PS: - Very good!
Fatima Pimenta (PS): - In the National Health Service, particularly in hospitals and health centers, this strength has been developed by doctors stomatologists and oral hygiene, and some - you know - that does not provide adequate coverage to the needs population. But President, the decision on health policy must be guided by principles is bound to get the gains in health.
Studies show that most oral diseases are preventable provided that the necessary basic measures of prevention are available. The PS took and took it. Thus, investment in the National Oral Health, the National Network of Health Promoting Schools program on oral health and disability are also good examples. Data from the Directorate General of Health indicate that between 1994 and 1998, is a consolidated strategy for the prevention of oral diseases to the integration of oral hygiene in the health centers.
In 2000, there was the first National Study for Prevention of Dental Caries and redefined is the strategy of intervention in oral health. It is a socialist government that is the first time, the treatment of children and adolescents. To the achievement of that goal reached in 1999 through a contract, an agreement between the Directorate General for Health and the Order of Doctors and Dentists in 2000, consolidated the system for the treatment of children, giving effect to the a value of 1 150 000 euros for this purpose.
Helena Terra (PS): - Very good!
Fatima Pimenta (PS): - At the oral health program for the socialist government invested in health education. Thus, the active collaboration between schools and health centers with the aim of taking on a complementary basis, the promotion of oral health, has led, in 1994, the creation of the National Network of Health Promoting Schools In 2002, the Government had fulfilled its goal, achieving a membership of 3,400 schools supported by 370 health centers.
The good practices developed by schools that belonged to the network led the World Health Organization to consider them priority in their strategies for the coming years. The challenge of the socialist governments in the prevention was the right decision and the evidence proved it. Otherwise, see the study's data on the prevalence of dental caries in children and young people, according to data from the last study in 2000 concluded that there was a significant reduction when compared with the beginning of the program in 1986, mainly in age groups between 6 and 12 years. The age of 12 years had an index (which marks the number of teeth decayed, missing and filled) which was admitted in patterns by the World Health Organization. So we were not so bad as that because the World Health Organization for this age group has a rate of 3% and we had 2.9% in 2000. It must be published data from 2005 to check whether this index does not meet the standards of the World Health Organization.
José Junqueiro (PS): - Well remembered!
Fatima Pimenta (PS): - In the age of 6 years, 33% of children were caries-free, versus 10% in 1986. These results, compared with the beginning of the program, reflect significant gains in health that must be emphasized. We therefore reduced by 50% the prevalence of the disease. Here is the proof of the good choice we made.
Helena Terra (PS): - Very good!
Fatima Pimenta (PS): - For the treatment of children and youth, an initiative of the Socialist Party, between 2000 and 2004 were treated for free, ie without any cost to the family, 143 700 children between 6 and 16 years of age . In 2006, a clear sign affixed to the strategy started in 2000, undertaking the program of socialist government, was allocated a budget of 4 million euros. Therefore, Mr Carlos Miranda, not disinvest, as I said earlier, the increased amount. Compare it to the party that gave this program: increased almost twice in the ceiling that we had in 2004.
Therefore, it should be noted that the system has had a membership of progressive stomatologists of doctors and dentists. Otherwise, here are the numbers: in 2000, had 400 stomatologists and doctors and dentists in 2004. had in 1136. This means that this model has been successful. Thus, the medical and dental care not met by the National Health Service are made by a responsible partnership between the public and private.
Prevention is assumed by the health services and in this - it is worth remembering - we have 115 professionals in oral health in the tables of health centers - so we did things - and 115 hygienists working in these oral appliances, which are, in total, 113 . Therefore, it is important to remember that there is not an oasis but there is a void. It is important that we have in mind that the responsibility for oral health services of the Directorate General of Health says that more important than having doctors dentists in health centers is to have oral hygiene. There is, therefore, that political and technical decisions are consistent, and that is what is important.
The Left Block and the CDS intend to include in the National Health Service dentists and doctors. If the CDS is even curious that a party whose ideological matrix favors private enterprise, then, less government, will now ask the dentist to integrate career top health. So for sure there will be reasons that reason knows where ...
This attitude, as well as curious, it is demagogic.
Mr. President: - Ladies, please to complete.
Fatima Pimenta (PS): - What is imperative is to save resources, which combats the waste to achieve gains in efficiency, to achieve improved levels of access and quality of care for populations. Only this way can the viability of the National Health.
The Socialist Party will meet its election commitments. Continue in the coming years the effort to invest in oral health of children and young people in order to ensure coverage of 100% within the deadline, giving effect to the goals of the National Health Gains in health achieved in the National Plan for Oral Health show that this is the path.
What matters is that, despite the problems that still exist in access to healthcare for the people, the report of the World Health Organization, 2000, which compares the health systems of 191 countries, Portugal ranked a creditable 12th place, which should make us be proud. Do not underestimate what good now built into our democracy. Let us give it sustainability. The Socialist Party is proud of one of the greatest achievements of April: the National Health.
Applause from the PS.
Mr. President - Ladies, there will be time to ask for clarification from the lady who has just spoken, because there is no time for answers, but you still have time can sign up for second interventions. For a speech, you have the floor Bernardino Soares.
Bernardino Soares (PCP) - Mr. President, Honorable Members, today reissued a debate that we did in past legislatures on an issue very important, which is the oral health, and that is the example of the failure of the Constitution regarding access to health care. The Constitution says that the National Health Service, an instrument for the realization of the right to health, should be universal and general, ie it must cover all medical care deemed necessary for a complete and overall health. In our country, this "general" was always with the teeth part, because the oral health care have never been covered by the care provided by the National Health Service, and each time is less, with the gradual disappearance of stomatologists and the non-inclusion in dentistry in the National Health Service.
We already know how the government interprets the Constitution, has a unique interpretation. The words "tend to free ', the Government states' tend to pay", the words "social cost of drugs" the government states' transfer to users of increasing costs of medicines "and the words" National Service General Health 'the Government states' National Health Service with fewer answers.
The only question seems abstract, but here is a concrete outcrop very important: we need a response in health centers, in hospitals, of size much greater than we have today so that people, citizens have access to oral health care. If this is so, then only is integrating the National Health Service, not in mass, as the PSD, significant numbers of doctors dentists, opening for such a career in dentistry in medical National Health Service, so as other areas, there are public services, response to this very great need of health care.
It is not worth saying that this can be resolved only with convention. Not true! Currently, the shortage is such that certainly need to go to convention. But one thing is to use conventional abdicating a public response, another - that, yes, correct, and complying the Constitution - is to keep in view the needs, the use of provision agreed, but there is more work to respond in public services, and that is what the governments have not done over the years.
Nor is worth saying, as Fatima Pimenta (or it seemed to me to mean) that this be resolved only with prevention. Prevention is very important, but then there is everything else. Else would do enough prevention in all specialties in the National Health Service, and the rest is just way. It is not so, we must prevent - and therefore value very important steps that were taken in that direction - but we must tackle the serious problem of oral health that we have in the general population of our country, and that this government is not showing signs of doing.
This debate gives us a really very interesting and even curious, that is to, in this respect, terms up to the CDS, but in a restrained, bound to defend the role of public health professionals.
Nuno Magalhães (CDS-PP): - Why is it fair!
Bernardino Soares (PCP): - I think this is very curious. But even more curious than the sudden conversion of the CDS to the benefits of tying the career of public and government is the answer of the Socialist Party. We have, during this debate, why the Socialist Party does not want medical dental health services. Not want the public to be public, as we have see from the statements and measures of the government. The PS does not want the doctors dentists in the National Health Service is planning public because, as the dental, other specialties will also be more private, and this is going against its policy.
This is a good example of inequality in access to health care. Who has money can have access to health care in our country, and with great quality, because we have good professional and well-equipped surgeries and clinics. But who does not have money can not, and there is that the problem is. In this example we see as essential for the right to health is for everyone, that the National Health Service has answers. And in this case the National Health Service has no answer.
What is the consequence? Who has no money has more difficulty in gaining access to these oral health care and therefore it is important to dignify and increase the response of the National Health. Therefore, we must remember, just as the Constitution, which to ensure the right to health is the country a key tool: the National Health Service general, universal and tend charged. So he remains in the Constitution, so it remains in practice government, which has not happened recently.
The truth is that integration of these professionals in the National Health Service costs money. But much more expensive cost to lack of oral health in the country that people are much more expensive cost to a country where the right to health is not for everyone because, no public response, the discrimination we have to work and we a serious problem of oral health in the general population of our country.
Applause of PCP.
Mr. President: - In a speech, has the floor Mr Francisco Madeira Lopes.
Francisco Madeira Lopes (The Greens): - Mr. President, Honorable Members, the situation of oral health of Portuguese is very serious. As is known, 60% of the population has no access to economic opportunities for oral health. It is known that in general, there is dentistry in our hospitals and health centers and only 10% of patients who lost their teeth is that they are rehabilitated with dental prosthesis. All this leads to that Portugal has the worst levels of oral health in the European Union. Therefore, the Ecologist Party "The Greens' means that it is essential to integration of oral health, as a full, in the National Health Service to prevent and to treat, first and before anything else, while care primary health, because it is essential to start with this field. I do not mean mere corrections with aesthetic significance, which, over time, we could reach, but, rather, the primary health care, basic, and should be guaranteed in light of our Constitution of the Republic.
Many other diseases could be detected off-time and therefore often the first symptoms are a reflection of the patient's oral health. Dentition in a bad state is because of multiple rheas and malaise of patients, such as food and nutrition, social problems of integration and even access to certain professions in which the image is crucial.
Finally, say that there is no general health without oral health, and it is essential to integration of oral health care in the National Health Service, not only in terms of prevention, but in treatment. This is, moreover, a fundamental issue of equality. Due to the high costs of access to oral health care of outside the National Health Service, to private physicians, there is a question of equality of access that only the National Health Service could guarantee conditions. The Socialist Party has in this debate, considering that this problem be solved by the National Program for Promotion of Oral Health.
Undoubtedly, prevention is very important, especially for children and young people, but does not respond to all the problems, or the universe of people in need of oral health care, particularly in the diagnosis, treatment and rehabilitation. The Socialist Party argued with the lack of financial resources, with the deficit in health and with the insistence that there are other specialties that are not included in the National Health Service.
But one of the two: the PS or accepts and defends, as said, that the conquest of the National Health Service is a victory of April and of the Portuguese Constitution, and gives clear steps towards the extension of National Service health, and not contrary to, or, then the PS believes that financial issues are in short order, first, and gives no clear steps. Because Ms Mrs Fatima Pimenta, we think that this issue has no financial cost only the short term but the long term.
We are convinced that investment in the long term, in the area of primary health care and, in a comprehensive manner in the National Health Service for oral health care can bring economic benefits to the Government and to the country and is it that you do not want to accept, which is very worrying.
Mr. President: - For a second intervention, the floor you Ana Drago.
Ana Drago (BE) - Mr President, during this discussion were presented some arguments that are of particular concern, especially by the Socialist Party. There was even a time when Fatima Pimenta, the PS, and said we could think that was a joke: when presented the inclusion of dentistry in the National Health Service as a potential "atomic bomb" that will bring order to what it is an experience worthy of democratization of access to health care in Portugal over the past 25 years, ...
Fatima Pimenta (PS): - It was not what I said!
Ana Drago (BE): - ... whereas the oral health will give the cable system. The problem is that this starts to be an argument by the applicant of the Socialist Party. Begins to be, successively, by the responsible ministry and by the Honorable Members of the bench of the Socialist Party, the following speech: "This is coming to an end. We have to this corset. We have to contractually with private, we have to introduce privatization in many services".
Fatima Pimenta (PS): - We must take care of what achievements!
Ana Drago (BE) - So, what we knew and wanted, and the lady said to be a victory of the democratic regime, is about to end!
Voices of the PS: - Eh ...
Ana Drago (BE) - The Socialist Party believes that oral health is essential, which began a series of studies, protocols, programs and initiatives precisely because they think it is fundamental, yet insist on the reality does not meet the wishes of the Socialist Party because 60% of the Portuguese still have no access to treatment for dental care, one in five Portuguese have lost more than 10 teeth. This is the reality!
Fatima Pimenta (PS) - This is why we are in 12th place of the World Health Organization!
Ana Drago (BE) - ie, what we have now does not appear to be working. Our draft law proposes the same philosophy of winning the democratic regime, ie the state make a long-term investment, do so over three years in order to integrate the resources available, and is purchased equipment in order to monetize the long term health of the Portuguese, the same investment.
What you did not explain and did not say is how much it costs to make contracts with private clinics that we have a type of treatment and access to be universal.
Fatima Pimenta (PS): - I can explain!
Ana Drago (BE): - The accounts you do not! And what I can say is that it will leave more expensive. This logic of 'corset' the National Health Service and to make contracts with private, yes, will it be the 'atomic bomb' in the National Health Service ...
Fatima Pimenta (PS): - Do not go!
Ana Drago (BE): - ... and what is an achievement and a democratization of access to the Portuguese health care. It is a pity that the Socialist Party to do so.
Applause from BE.
Fatima Pimenta (PS): - Go see it will not be so!
Mr. President - Ladies and gentlemen, with the discussion of draft laws numbers 86 / X and 195 / X, concluding, therefore, our agenda for today.
The next plenary meeting will be held tomorrow, Thursday, March 23, at 15 hours, with a period before the agenda and a period on the agenda, which contain a discussion of the bill number 51 / X and the draft law numbers 105 / X, 208 / X, 209 / X and 106 / X, to be followed by a period of regimental votes.
Ladies and gentlemen, is closed the session.
Were 17 hours and 40 minutes.
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