Healthcare

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Portugal’s healthcare system provides universal access through public, occupational, and private options, yet significant regional and socioeconomic inequalities persist. Long waiting times and uneven distribution of facilities leave rural and vulnerable populations at a disadvantage, while wealthier residents increasingly rely on private care. Understanding these disparities is vital to ensure equitable access, improve workforce distribution, strengthen regional services, and support a healthcare system capable of meeting both current and future population needs.

Why does Portugal have one of the highest healthcare equality disparities Europe?

Healthcare System

Portugal’s healthcare system is built on three main pillars, ensuring access to medical care for all residents through a mix of public and private options.

1. National Health Service (The Servico Nacional de Saúde - SNS)

Established in 1979, the SNS provides universal, tax-funded healthcare under the supervision of the Ministry of Health. It offers comprehensive and largely free care to all residents who contribute to the social security system. The SNS covers the entire mainland, while the Azores and Madeira operate their own regional health systems.

2. Occupation-Based Health Subsystems

These social health insurance schemes are used in the public sector and in specific professions such as police, military, and banking. The largest subsystem is the ADSE (Instituto de Proteção e Assistência na Doença), which covers over 1.3 million public servants. Members of these subsystems can also access SNS hospital and services, and many receive reimbursement for private healthcare costs.

3. Voluntary Private Health Insurance

Many people choose private health insurance to supplement public coverage and gain faster access to private healthcare facilities.

Funding

Healthcare in Portugal is primarily financed through general taxation and social security contributions from working residents’ salaries. This model supports the Serviço Nacional de Saúde (SNS), which provides universal access to healthcare across mainland Portugal.

In addition to public funding, a significant portion of the population chooses to supplement their coverage with private health insurance. Approximately 25% of residents, around 3.7 million people currently hold private health insurance, a figure that has been steadily increasing. Another 1.5 million individuals are covered by public occupation-based health subsystems, which often include direct access to private healthcare providers.

The expansion of private health insurance is largely attributed to out-of-pocket costs, service delays, and limited availability of some treatments within the public sector.

While Portugal’s Serviço Nacional de Saúde (SNS) provides comprehensive healthcare, access to certain specialties can be limited due to high demand and long waiting times. A May 2022 study found that 48.7% of respondents had difficulty obtaining specialist consultations, with 30.2% waiting over three months. As a result, many residents and expatriates choose private health insurance to gain faster access to specialists, diagnostic tests, and hospital care through private healthcare networks. (UEHP. “The Main Priorities for the Private Health Sector in Portugal in 2024 - UEHP,” 2024.), (Properstar. “Healthcare in Portugal: System, Costs, and How to Access It.” Properstar, November 23, 2018.).

Portugal's centralised network for healthcare

Inequalities

Portugal is one of the European countries with the highest health inequalities (Inês Campos-Matos, Giuliano Russo, and Julian Perelman, “Connecting the Dots on Health Inequalities – a Systematic Review on the Social Determinants of Health in Portugal, 2016). Despite having a universal public healthcare system, Portugal faces significant regional and socioeconomic disparities in access to care. Public hospitals often suffer from extended waiting times for surgeries and specialist appointments, leading many patients to who can afford it to seek private healthcare, widening the gap between income groups. Older and vulnerable populations are more likely to experience poorer health outcomes. These inequalities highlight the need for investment in regional services and workforce distribution to ensure equitable access to treatment across the country.