Healthcare in Portugal
The coronavirus pandemic has shed new light on myriad issues – underscoring the importance of family and friends and forcing us to adapt to new ways of working and living. The COVID-19 crisis has also thrown into sharp focus the need to prioritise healthcare when considering an international relocation.
Portugal boasts plenty of compelling reasons to call it home, from its unparalleled quality of life and enviably low cost of living to its easy-to-reach beaches and charming countryside. In addition, Portugal also offers a quality healthcare system – though, admittedly, one that often requires a bit of insider knowledge to navigate.
“Portugal is absolutely on par with any other European power or with the United States in terms of overall quality of care,” said Dr. Pedro Mata, a Lisbon-based immunologist who heads the city’s Instituto Clínico de Alergologia, adding, “still, Portugal is a ‘Latin’ country, where the most important thing is that human connection. For that reason, finding a good General Practitioner – someone with experience and a good network with whom you feel comfortable – is really key. Without that ‘inside advisor,’ people who don’t know the system sometimes hit hurdles. A good GP will help you avoid those hurdles and probably end up making things easier than they would have been in pretty much any other country in the world.”
Part of the complexity lies in the country’s three-tiered system, which includes the Sistema Nacional de Saúde, or SNS, which provides universal basic healthcare to anyone in Portuguese national territory, irrespective of nationality or immigration status; private insurance companies and healthcare providers; as well as purely private doctors, without any affiliation to private insurers.
Founded in the late 1970s, in the wake of the authoritarian Salazar regime, the SNS helped usher Portugal out of its long period of isolation and backwardness and into the wider European fold. Life expectancies in the country skyrocketed in the wake of the creation of the SNS, and – with life expectancy at birth averaging 81.75 years in 2020 – the country is now among the world’s longest-lived.
While anyone will be granted emergency treatment through the SNS, in order to use the system regularly, foreign nationals with legal residence in Portugal must obtain a Número de Utente, or registration number, through the Unidade de Saúde da Família, or family clinic, nearest their residence. Required documents generally include the residence permit and Tax Identification Number or NIF. While costs associated with treatment through the public system are minimal (most consultas, or routine appointments, cost just €4.50 euros,) foreign nationals without a Número de Utente do have to pay for treatment. Even so, the costs are far lower than what could be expected under similar circumstances in the United States, with procedures such as emergency surgeries resulting in bills in the range of hundreds – not thousands – of euros.
Austerity measures imposed during the country’s biting 2010-2014 financial crisis led to widespread personnel cuts in the SNS, the effects of which still make themselves felt today. As a result, the system is plagued by long wait times that have increasingly pushed Portuguese families of means to turn to the private sector for more timely responses. The country’s main private healthcare providers, including the CUF and Hospital da Luz groups, tend to have agreements with private insurance companies, covering procedures undergone in those establishments. Private insurance plans tend to be quite reasonably priced, particularly when comparing with health insurance rates in the United States, with visits to affiliated specialists charged at a flat rate of about €35 euros, depending on the insurance company and plan. Dr. Mata recommends opting for a plan that emphasises hospitalisation over coverage for routine appointments, as doctors’ visits are generally very reasonably priced and not having to remain in-network allows for greater speed and flexibility in responding to specific health needs.
“While many might not have the most luxurious conditions, public hospitals in Portugal are able to respond to almost any emergency situation in the ‘correct’ manner, at any time of day, and any day of the year, with the same outcomes as you would see in any developed country,” said Dr. Mata. “The issue is that in public hospitals, the staff is stretched thin, so you’re not going to get the same doting attention from the personnel. They will do their job professionally, but you’re not going to be pampered and catered to in the same way as you would in some hospitals in some other countries.”
That stands in stark contrast with the country’s private institutions.
“The conditions in private hospitals are quite high and in fact can go head-to-head with pretty much any hospital in the rest of Europe or the U.S,” said Dr. Mata. For patients of Portugal’s private hospital, the key lies in identifying the institution that focuses on the speciality in question. Because most private hospitals don’t staff all specialities every day of the week, patients seeking out a particular specialist may have to wait.
In Lisbon, the top hospitals for the following pathologies include:
- For high-end accommodations and treatment: Hospital CUF Tejo (private)
- For cancer treatment: Instituto Português da Oncologia (public) and Fundação Champalimaud (private)
- For cardiology: Hospital da Luz (private)
- For orthopaedics: CUF Descobertas (private)
- For ear, nose and throat: CUF Tejo (This private hospital has a full-time staff of 35 ENT specialists.)
- For gastroenterology: Hospital da Lusíadas (private)
Additionally, there are purely private doctors without any affiliation with an insurance company – such as Dr. Mata himself – who generally charge between €80-€120 euros per appointment. The advantage of seeing non-affiliated doctors is that they generally spend significantly more time with each patient than other physicians. (It’s also important to note that nearly all doctors, as well as many nurses in Portugal, speak English, and a considerable number of them also speak French, so communication with foreign patients is generally not a problem.)
“In Portugal, you really are going to get top-of-the-line treatment, particularly when you have an insider helping guide you through,” said Dr. Mata, adding that he’s considering starting a concierge service to help new residents navigate the Portuguese healthcare system.