Portugal

Portugal’s National Health Service (NHS) is a universal health system covering all residents, regardless of their socioeconomic, employment or legal status.  The Ministry of Health concentrates most planning and regulation centrally, while the five regional health administrations manage the NHS at the local level. 

The NHS also coexists with health subsystems; that is, special health insurance schemes that provide coverage for particular professions or sectors, either in the public or private sector (e.g. the scheme for civil servants and the banking sector, respectively). 

The NHS is predominantly financed through general taxation. The financing structure of the Portuguese health system is characterized by a relatively high reliance on out-of-pocket (OOP) expenditure, and to a lesser extent, on premiums to private insurance schemes and mutual institutions. In 2020, fixed user charges for primary care and NHS-prescribed services were eliminated, and in 2022 all such charges within the NHS were abolished, except for emergency care not requiring hospital admission (unless referred through SNS 24, the digital platform of the Portuguese NHS). Co-payments for a variety of services remain.

Portuguese primary care is delivered by a mix of public and private health service providers. The NHS predominantly provides primary care and acute general and specialized hospital care. Dental consultations, diagnostic services, renal dialysis, and rehabilitation are more commonly provided in the private sector (but with public funding to a considerable extent) under contractual arrangements with the NHS. The creation of Family Health Units, in 2007, and Primary Healthcare Centre Groups, in 2008, restructured the organization of Portuguese primary care to provide integrated primary care for the local population. Secondary and tertiary care is mainly provided in hospitals, which are grouped into Hospital Centres covering a given geographical area.