ULS has a maximum funding of 14 billion in 2027

A39 local health units (ULS) will have a maximum funding of EUR 14 billion in 2027 and the award of performance premiums is still planned if they exceed the contractual objectives.

The maximum amount now defined is set out in the Terms of Reference for the Contractualization of Health Care in the SNS, published by the Central Health System Administration (ACSS), and laying down the guidelines and rules for the financing of ULS and oncology institutes (IPO) next year.

“The overall funding limits allocated to each ULS entity in 2027 cannot be exceeded, so the defined values must be respected,” says the ACSS document and the Executive Board of the National Health Service (SNS) currently consulted by Lusa.

In the final amounts provided for in the Terms of Reference, the ULS of Coimbra is highlighted, with a ceiling of more than EUR 940 million, followed by that of São José (797 million), São João (797 million), Santa Maria (764 million) and Santo António (761 million).

At a second level of maximum funding for 2027 are the Amadora-Sintra ULS (EUR 571 million), West Lisbon (535 million), Vila Nova de Gaia-Espinho (514 million) and Almada-Seixal (453 million).

For the three IPOs, a final amount of EUR 572 million is defined, distributed by 242 million for Lisbon, 234 million for Porto and 95 million for Coimbra.

ACSS and DE-SNS report that the Terms of Reference for 2027 intend to introduce changes in the way of assessing the performance of health units, placing the “focus on the results that express the quality of care provided in the SNS”.

“ After establishing the guiding principles and the rules of the contractualization methodology, including the methodology for the calculation of financing of the ULS and IPOs, the conditions for initiating the 2027 contractualization process, of which the negotiation meetings are part, are met, with a view to signing the programme contract, ACSS and DE-SNS are advanced in the document.

For the next year, the Terms of Reference also provide a specific methodology for emergencies to be included in the program contracts to be signed with each ULS, with the aim of ensuring the continuity of the availability of these services.

“ In order to ensure the accountability of the ULS for the effective availability of emergency services, the financing of service availability is composed of a fixed component of 75% and a variable component of 25%, thus creating a mechanism that ensures that the financing of emergencies is not limited to the registration of a contractual value, but depends on the maintenance of the service’s continuous availability, determines the document.

In addition to institutional incentives, a performance premium to be awarded to ULSs that “are able to highlight the fulfilment of the contractual objectives, within the indicators established for the institution’s Global Performance Index (GDI) in 2027, above 100% and up to 120%”.

In order to promote increased SNS efficiency, the value of the premium will correspond to a maximum of 5% of the amount of institutional incentives of each entity and can be used to “preferably reward departments and services that have exceeded the objectives defined in terms of internal contractualisation”.

The funding of the ELUs for 2027 will take into account risk-adjusted capitation, user flows between institutions, differentiation level and specific programmes.

The timetable provides for the negotiation meetings to be held by 11 December between the Executive Board of the SNS and the IPOs, together with the ACSS.

“ From the negotiation meetings of external contractualization results the commitments made for signing the 2027 program contract, being signed until December 31, 2026”, they also refer to the Terms of Reference.