Scope This article examines the structural and institutional factors contributing to the high cost of assistive products within the Portuguese Service Delivery Model between 2011 and 2022. It situates the Portuguese framework within a broader European context through a comparative analysis with Spain, Italy, and Ireland, aiming to identify operational inefficiencies that hinder the universalisation of access. Method The study employs a longitudinal analysis of national budgetary data and beneficiary trends, complemented by a comparative review of international service delivery models. To evaluate long-term sustainability, expenditure projections for 2035 and 2050 were calculated using the 2022 executed expenditure as a baseline, applying a Compound Annual Growth Rate (CAGR) of 3.43% derived from historical trends. The research evaluates the relationship between public R&D investment, market competition, and end-user affordability through the ‘entrepreneurial state’ framework. Key Findings The study identifies ‘financial paradox’: while total executed expenditure nearly quadrupled (from €9.9M to €37.7M) between 2011 and 2022, the total number of people supported declined by 22% (from 24,511 to 19,123 individuals), resulting in a nearly fivefold increase in the average cost per beneficiary. This trajectory indicates that the ecosystem has shifted towards a ‘value-based pricing’ logic, mirroring the pharmaceutical industry’s strategy of setting prices according to the state’s maximum fiscal capacity rather than actual production expenditure, leading to a ‘double charging’ of taxpayers where public funds de-risk the market without ensuring equitable returns. To address this, the findings advocate for a structural policy adjustment that includes integrating social conditionalities into R&D funding, promoting mass customisation and open-source distributed manufacturing to decouple autonomy from market-driven price rigidity, and reducing regulatory barriers to reposition assistive products as essential public infrastructures rather than niche commodities.
Pedro Nuno de Oliveira (Mon,) studied this question.