Understanding the Portuguese Healthcare System

The Public System

The public healthcare system is the main healthcare system in Portugal. It is available to all legal residents in Portugal, which means that as a resident you’ll be able to use this system.

If you come from a country that does not have public healthcare, such as the US or most non-EU countries, this is a huge upgrade as it means you now have a huge safety net. Should you be unfortunate enough to get in a car accident, get cancer, need a knee operation, or anything else, you will be treated—and you won’t need to show health insurance.

Public healthcare in Portugal covers almost all medical needs, though there are some exceptions like dental care. There are no exclusions and it’s certainly not for emergencies only, but many expats (and an increasing number of Portuguese) choose to use the private system for many routine procedures. This is due to waiting lists on the public system, which can be long if your situation is considered non-urgent.

However, it’s important to understand that the public system isn’t a second rate or step down from the private system. You may have nicer hospitals in the private system, faster waiting times, or maybe even friendlier doctors, but the public system is the considerably bigger and better-equipped system, and the one you’ll need to use for a lot of serious treatments.

• What if I haven’t paid into the system? This system is funded through taxes that come from a variety of sources, whether that’s social security or the taxes paid on something as small as a cup of coffee. You may not have worked in Portugal, but you’ll still be paying into the system.

• When can I register? You are eligible to use the system once you become a resident (typically after your AIMA appointment for non-EU/EEA/Swiss citizens or, for EU citizens, once you receive your CRUE. To access the system, you’ll need to register at your local centro de saúde and get a Número de Utente (healthcare number). Ideally, you’ll be assigned a family doctor, but due to staff shortages, you might see rotating doctors instead.
• Do doctors speak English? Doctors will often speak English, particularly in regions like Lisbon and the Algarve, but it isn’t guaranteed. Nurses and other hospital staff are less likely to, making some knowledge of Portuguese important. Otherwise, consider bringing a translator or Portuguese-speaking friend.  
• Are there any costs? The cost of using the public system is essentially free, assuming you’re a resident with an SNS number or número de utente. There are sometimes some small charges – €5 here and €20 there – which makes it slightly different from other countries where treatment is completely free, but the costs are so low it’s almost negligible. 

Downsides of the public system

Although the public system has its pros, it has many downsides (some of which have already been mentioned).

• Like the healthcare systems in many other European countries, waiting lists are long.
• Getting a family doctor or GP is another issue: more than one million Portuguese do not have a family doctor [source].
• Another issue is the lack of a centralised medical record sharing system: with the exception of a few clusters within the private and public systems, medical records are generally not shared between hospitals. 
• Communication and complexity is another issue, often related to Portuguese culture.

After three years we are still waiting to get assigned a doctor from the local health care facility, but the COVID vaccinations were ultimately well handled.

Kurt

The biggest challenge is understanding how to navigate the Portuguese system. There are fantastic doctors and nurses within both the private and public sector, but most patients don’t know which doctors and specialists they need to see – and, unfortunately, it’s often up to the patient to know how to navigate the system.

Dr. Michael Averbukh, CEO of Serenity Portugal

Registering

Once you are a resident of Portugal (i.e. you have your residency permit), you can register to use the public healthcare system. This is normally done by registering at your local centro de saúde however, you can also register at an Espaço Cidadão as well.

In practice, some people struggle to register. They are often asked for NISS numbers or other documentation or told that the public system isn’t available for retirees.

If you have issues registering at your centro de saúde, you should try an Espaço Cidadão instead.

The Private System 

While the public system is funded through taxes, the private system is paid for directly by the patient (often significantly reduced through heaving health insurance) and it can be used by either residents or non-residents.

• It has shorter waiting lists.
• You can book to see a specialist without having to wait for a referral.
• Staff are more likely to speak English (as well as many other languages). In fact, many private hospital websites allow you to search for doctors based on the languages they speak. 

I arrived in Portugal on the 31st March 2022 at the age of 84. Unfortunately after being here for 6 weeks I fell and had to have a hip replacement. I found the hospital in Alvor extremely efficient friendly and well run. I am now recovered and I am enjoying the shopping where mostly everyone speaks English and are very friendly and helpful.

Millie (Portugalist reader)

Having retuned to the UK for medical reasons, I returned to Portugal after my operation. The care I received from people whilst being sick was touching. The private clinics I visited were very efficient and most people spoke English at the private hospitals. 

Aliya (Portugalist reader)

Downsides of the private system

However, even though many expats prefer to use the private system as much as possible, it has a few downsides to consider.

• Costs: It costs money to use it. This can be paid directly or through insurance. As costs are lower in Portugal, some people choose to pay out-of-pocket rather than pay for an insurance plan.
• Limitations: Hospitals are smaller and less well-equipped than public hospitals. If you need serious treatments, such as cancer treatment or a transplant, you will need to go through the public system—although you may find it faster to get referred by a doctor in the private system.
• Locations: While there are lots of private hospitals in places like Lisbon and the Algarve, there may be fewer options in rural parts of Portugal.

Should You Take Out Insurance?

If you’re planning on using the private hospitals, you may be wondering whether you should take out insurance. Most people do, however, some people may decide to simply put money into a savings account—particularly if they are above 70 or have a pre-existing condition and so don’t have as many companies willing to cover you.

If you are moving to Portugal as a non-EU/EEA/Swiss citizen on a visa like the D7 or D8, you will most likely need to take our insurance for your AIMA appointment. The question is whether you continue it after your residency is approved and you’re eligible for the public system?

• Insurance usually makes financial sense: While a co-payment is typically required, having health insurance significantly reduces the final bill and insurance is recommended if you plan to use private hospitals.
• Shop around: Using a broker is recommended, especially when you first move to Portugal. Although you can easily buy health insurance – it’ll be offered to you when you open a bank account, for example – no two policies are the same and you need to find the one that’s right for you. If you have a Serenity membership, they can also look at the quotes and decide which one they think best suits your needs based on your medical information.
• Pre-existing conditions aren’t always covered: With the exception of one insurance company (and another one or two possibles), pre-existing conditions are generally not covered by insurance. The public system, on the other hand, does not have this restriction. 
• English is spoken: Most health insurance companies usually have an English-speaking helpline. This can be helpful, but the person on the other end of the line is usually only able to tell you which hospitals nearby will work with your insurance policy – and not necessarily which doctor you need. 

Dentistry 

Dentistry is rarely offered for free under the public system. It is, however, reasonably affordable by international standards and made even more affordable by having a qualifying health insurance. 

What About Travelling to Other Countries?

Travelling to other European countries

• As a Portuguese resident, you’ll be eligible for the European Health Insurance Card (EHIC). You can apply for the card through the Portuguese healthcare system once you’ve established residency.
• This card grants you access to public healthcare across most European countries for up to 90 days at a time, allowing you to receive medical treatment on the same basis as residents of the country you’re visiting. As well as EU countries, it’s also valid in Iceland, Liechtenstein, Norway, and Switzerland.
• When using the EHIC, you may need to pay for treatment upfront and then claim reimbursement later. The costs, payment requirements, and reimbursement policies can vary depending on the healthcare system of the country you’re visiting. Each family member will need their own EHIC, which is free of charge.
• It’s important to note that the EHIC has limitations. While it provides coverage for medically necessary health services, it’s not a substitute for comprehensive travel insurance. The card doesn’t cover private healthcare or the cost of being flown home in case of injury or illness.
• For travel to countries not covered by the EHIC, or for additional protection, you’ll need to purchase private travel insurance that covers health-related issues and medical expenses. This is especially important for travel outside of Europe, where the EHIC won’t provide any coverage.

More information about requesting the EHIC card can be found here.

Further Reading

• These Are the Economies With the Most (and Least) Efficient Health Care
• The world health report 2000
• Euro Health Consumer Index 2018