Portugal is situated in southern Europe on the Iberian Peninsula, with a population of 10.5 million people in 2023 and an average life expectancy of 82 years in 2022.
The 1974 political revolution “led to the creation of the Portuguese National Health Service (NHS) as a universal and tax-based system”. Today, Portugal’s NHS is still “a universal, predominantly tax-financed health system covering all residents, including asylum seekers and migrants”. A new statute of the NHS, adopted in 2022 [link 2], created an executive board for the NHS to simplify the health service’s organizational structure and better coordinate providers.
Portugal’s health care delivery system, as described by [link 3] the European Observatory on Health Systems and Policies (the Observatory) and the Organisation for Economic Co-operation and Development (OECD), comprises public and private providers delivering primary and hospital care, with general practitioners acting as gatekeepers to specialist and secondary care, overseen by the Ministry of Health of Portugal:
The Ministry of Health consolidates most planning, monitoring, guidance and regulatory activities. At the local level, five regional health administrations are responsible for supervising NHS hospitals, managing public primary care centres and providers, and executing national health policy objectives. … In addition to the NHS, healthcare coverage is provided through two … supplementary channels. The first one comprises various (public and private) health sub-systems – insurance schemes covering specific professional groups such as civil servants, military personnel and workers in other specific sectors. The second channel involves private voluntary health insurance (VHI), which provides access to additional benefits.
The Portuguese NHS 2024 reform was implemented to vertically integrate health services from different levels of care–primary, secondary and tertiary. This allows streamlining and flattening of the hierarchical structure of NHS, so that it will comprise 44 institutions, or fewer than half the pre-reform number.
Since 2000, health spending in Portugal is lower than the European Union (EU) average, which in 2021 stood at US$ 4,215 in the EU while it was at US$ 2,747 in Portugal. However, current health expenditure (CHE), when measured as a percentage of gross domestic product (GDP), was at the EU average level in recent years. In 2021, CHE as a percentage of GDP in Portugal was at 11.14%, surpassing the EU average of 10.95%. Since 2000, public sources of funding covered a smaller share of health expenditure in Portugal than in the EU, with 63.11% in Portugal versus 76.49% in the EU in 2021. Conversely, the share of out-of-pocket (OOP) expenditure is almost twice as high, at 28.99% in Portugal compared to 14.55% in the EU in 2021. The challenges that the health system of Portugal faces include unmet needs [link 3], which are “disproportionately concentrated among low-income groups, especially for dental care” and OOP spending that is double the EU average. According to the Observatory and OECD [link 3], “recent reforms expanded the scope of public coverage for several health services”. Portugal’s country health profile further explains:
To reduce financial barriers to healthcare access, the Portuguese government introduced wide exemptions from cost-sharing applying to over 50 % of the population in recent years. In 2020, user charges for primary care and NHS-prescribed services were eliminated, and in 2022 all charges within the NHS were abolished, except for emergency care not requiring hospital admission.
