Healthcare

Fig.ME.P.HC.01; Authors Own, 'Healthcare Sketch'

RESEARCH JUSTIFICATION

Portugal’s healthcare system aims to provide universal access through public, occupational, and private options. Despite this, significant regional and socioeconomic inequalities persist.

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

Healthcare System

Portugal’s healthcare system is built on three main pillars, aiming to provide access to medical care for all the population through a mix of public and private services:

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 largely free care to all residents who contribute to the social security system, covering the entire mainland, while the Azores and Madeira operate their own regional health systems.

2. Occupation-Based Health Subsystems

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 hospitals 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. The expansion of private health insurance is largely attributed to service delays and limited availability of some treatments within the public sector.

Fig.ME.P.HC.02; Authors Own, 'Portugal's centralised network for healthcare', based on, (Properstar, “Healthcare in Portugal: System, Costs, and How to Access It.” Properstar, November 23, 2018)

Approximately 25% of residents, around 3.7 million people currently hold private health insurance, a figure that has been steadily increasing.

(The Portugal News, "Portuguese above EU average for health coverage", 2025)

Inequalities

Despite having a universal public healthcare system, Portugal faces significant regional and socioeconomic disparities in access to care.

‘Portugal has one of the highest rate of health inequalities within the EU.’

(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)

Public hospitals often suffer from extended waiting times for surgeries and specialist appointments, leading many patients who can afford it, to seek private healthcare. These inequalities highlight the need to ensure equitable access to treatment across the country. (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)

Fig.ME.P.HC.04; Authors Own, 'Number of People in Portugal using Additional Health Insurance', based on, ("Census 2021", Instituto Nacional De Estatistica Statistics Portugal, 2021)

Fig.ME.P.HC.03; Authors Own, 'Patients without GP's in Portugal', based on,

("Census 2021", Instituto Nacional De Estatistica Statistics Portugal, 2021)

A study amongst SNS patients found that 48.7% of respondents had difficulty obtaining specialist consultations, with 30.2% waiting over three months.

(The Portugal News, “Hospital waiting times concerning Portuguese”, 2022)

Family Healthcare Units

In 2005, Family Healthcare Units (USF - Unidades de Saúde Familiares) were introduced as part of a major reform of the Portugal’s National Health Service (SNS).

These small, community based primary healthcare units replaced an inefficient healthcare model and were designed to ensure that every resident is registered with a family doctor. By addressing most health needs locally, USFs reduce pressure on hospital emergency departments. (Portuguese Ministry of Health, SNS reform, 2005). However, like much of Portugal’s health system, this typology has not yet achieved full national accessibility.

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Fig.ME.P.HC.05; Authors Own, 'Patient Journey Sketch'

'In May of 2025, the number of people without a family doctor reached a record high, with 1.6 million individuals affected.'

(The Portugal News, 2025)