Health Care in Portugal - Public vs Private



One of the things that can be very attractive to future residents is our public health care system, Sistema Nacional de Saúde (SNS) especially if you come from a country where it’s lacking one. Urgent care is accessible to anyone in the country with a Visa, including a tourist visa. However, to get full care and follow up appointments and check-ups, you do need to have a residence permit.


Any of the visas that allow you to have a residency (student visa, D7 visa, Golden Visa, work visa, entrepreneur visa, etc) give access to the Public Health System (SNS).


All you need to do is :

1. Get Residency, with it a residency card 2. Request a health user number (Número de Utente) 3. Request your Social Security number (Segurança Social) – it’s usually on the residency card 4. Sign up in a Centro de Saúde (Health Center) close to where you are living


You now have full access to the Public Health System in Portugal 😊


Everything from surgeries to medication is covered and you only have to pay small co-payment fees that follow:


General Medicine/ Family Doctor /Nursing- 4,5€

Specialty Appointments – 7€

Trips to Urgent care – 14€ to 18€ depending on the care needed


Households whose income is below what is considered the poverty line are exempt from these fees.

Most medicines are almost fully supported, you pay a very small percentage of the price, especially for chronic illnesses. But you do need to have a prescription.


Pros & Cons


PUBLIC HEALTH SYSTEM


Advantages: - Very low cost for the user - Family Doctor - Urgent care - Covers Medication - Covers follow up and all treatment needed - Has almost all specialties

- Has all the equipment, just sometimes not the most recent models


Disavantages: - Usually short staffed - Very long wait times - Often overcrowded - Old facilities, usually in need of renovation - Terrible customer service in 80% of the hospitals (forget phones)

- Hit or miss in professionalism & empathy of doctors - Low accountability (barely any repercussions for malpractice)

- Priority is given to seniors, pregnant women, and people with immediate life-threatening conditions.

- People who have health problems that are not considered life-threatening or urgent will be put on the waiting list and it can take quite a while, even for follow-up consultations, it can be something like 4 to 6 months. Surgery can take years.


PRIVATE HEALTH INSURANCE


Advantages: - Fast response times - Fast bookings - High quality infrastructure

- Usually newer equipments - Good customer service - Higher accountability (Doctors do get fired) - Wide choice


Disadvantages: - Monthly/Yearly Cost - Limits - Higher co-payments - Often private hospitals discard responsibility and send to public when faced complicated situations - Hit or miss in professionalism of doctors


Compared to other countries the cost of private health insurance in Portugal is quite affordable. It varies widely according to factors like age, risk, coverage, and preexisting conditions.


A practical example


I’ll use my own insurance as an example and term of comparison. I’m currently about to turn 31, I have a very high coverage insurance that I made when I was 26/7. I pay about 64€ a month that comes down to about 770€ a year.


My insurance covers:

- Consultations and surgeries up to 50K a year (keep in mind that’s a lot in Europe, the most high end complicated surgery will likely cost less than 30k)

- Childbirth (250€ co-payment)

- Dental, Ophthalmology, Medication

- 18€ co-payment for specialty appointments,

- 250€ copayment for surgery


There are insurances for as low as 15€, but they will obviously have much lower coverage and higher copayment rates.

High end insurances will also have international coverage and even higher limits (mine has a fairly limited international coverage), I believe the most expensive option for my age group costs about 96€ a month (+-1150€ a year)

As you know insurance tends to get pricier the older you get and there are also limits for how old you can be to make one, most insurances refuse people over 60, and all of them refuse over 75. However if you make the insurance sooner and keep it you can keep it as long as you want. High end insurances for older people are the most expensive but at the most they will go up to 220€ a month (2500€ a year).

Pre-existing conditions can be covered by insurance, but they are usually not. My insurance is one of those few that does cover pre-existing conditions; however there is a longer wait time to start using that coverage.


Relationship between Public & Private Health Systems


An interesting thing about Portugal’s dynamic on health systems is that even if you have private insurance, complicated surgeries are often sent to the public hospitals because private hospitals prefer to relocate that risk. I’ve seen a lot of cases of people who got sick and initially went to a private hospital, and later got transferred to a public hospital when the situation became critical.


Another interesting thing is that most doctors work in both private and public. The difference is mostly the time you need to wait to have a consultation.


A positive about having private insurance is that you have more liability with the doctors. I find that often when you catch a doctor that is not as caring, even in situations that come down to incompetence, it is very hard to get liability from the public system, while in private the complaint will likely be taken seriously.


In sum, I believe it can be very advantageous to have private insurance, it gives you flexibility, faster response times and takes pressure from the public system.

However, if you are over 60 in Portugal, I recommend not getting private insurance, just going public - although the waiting times are longer, with older age increases the risk factors, meaning you get priority on the public system. I find it’s not worth the inflated premiums that older age brings, geven the public system does a decent job and you can just take advantage of your senior priority in it.


If you are under 55, I would say investigate it since it can be a very good advantage. Although the public system is fairly good, it is very overcrowded and it’s better to have an alternative, given you can afford it.


I made a Live video about this topic where my experience was discussed in more detail and some questions were answered live, you can view it here :



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