Seven Northern Hospitals Are Asking Doctors to Enter the Funding Code Themselves, and Their Union Says a Diagnosis Cannot Be Picked for What It Pays

The Sindicato dos Médicos do Norte said on Monday that public hospitals across the north are requiring doctors to carry out the administrative work of coding diagnoses for funding purposes, and that the time this takes is coming directly out of patient care.

The union, which belongs to the Federação Nacional dos Médicos, named seven places where it says the practice is being introduced in emergency departments and outpatient clinics: Braga, Bragança, Gaia, Feira, Matosinhos, Porto and Viana do Castelo. "In a National Health Service short of doctors, where patients wait hours in the emergency department and months for an appointment, it is incomprehensible that hospital doctors should have time taken away from them for the administrative task of assigning alphanumeric codes to diagnoses," it said.

Where the money enters the room

The union's legal department set out why this is happening, in an opinion seen by the Lusa news agency. The trigger is the funding model for the unidades locais de saúde, the merged local health units, which receive funds according to the morbidity and complexity of the population they serve. Coding is how morbidity and complexity are demonstrated.

That produces a specific and uncomfortable incentive. Unspecific diagnosis codes, the opinion notes, using R69 as its example, do not generate "complexity" and therefore do not generate as much funding for the hospital. Its conclusion is blunt: "The motivation is therefore essentially financial and managerial, and not purely clinical."

The union draws a line from that observation. A doctor's job, it argues, is to observe, diagnose, treat and record clinical information correctly. Assigning administrative codes for the purpose of institutional financing is, in its words, "a materially different reality", and imposing it on hospital doctors generally "appears to lack any legal basis".

The sentence the union wants remembered

Alongside the workload complaint sits a sharper one. "There is a line that cannot be crossed," the SMN said. "No doctor can be pressured to assign, alter or make more specific a diagnosis without clinical grounds, in order to meet an institution's administrative or financial objectives." A diagnosis, it added, cannot be chosen for the money it is worth.

Its practical advice to members is procedural and deliberately so: keep clinical records rigorous, and when the new task is imposed, ask for the instruction in writing and contact the union. Any pressure to change a diagnosis without clinical grounds, it said, should be reported.

A service already counting its minutes

The complaint lands on a service where time is the scarcest input. Portugal's emergency departments lost 204 days to closures in the first half of this year, and the wait for a first psychologist appointment in the SNS runs to half a year. The new health framework published last week holds family-doctor coverage at 85.37 percent until 2028, which is an acknowledgement that capacity is not about to expand.

In that setting, an argument about who types a code is not a clerical dispute. Coding has to be done by somebody, because the funding model requires it and the money follows it. The question the SMN has put on the table is whether the person doing it should be the one the patient is waiting to see, and whether anyone has the legal authority to decide that they should.