Understanding healthcare in Portugal 

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Crystal Murno
Questions and concerns about healthcare are common for people moving to live in Portugal. Having ten years of experience working as a professional registered nurse and nurse educator licensed in the State of New York, I too had many questions when I arrived here in Caldas Da Rainha in January of 2023. Since that time, I have had the opportunity to learn about the healthcare system here from both personal experience and from my own research. This article is the first in a series of articles about healthcare in Portugal. In this article, I hope to shed some light on the differences between the public healthcare system and the private health care system.

Public healthcare
Portugal provides comprehensive healthcare services to legal residents in Portugal through the national health service (servíço nacional de saúde or SNS). These services are funded through taxes and offer no-fee or low-fee non-emergency medical care. There is a small fee for emergency care that is sought without referral from a public physician. Registration at the local health center (Centro de Saúde) is required to obtain a health number (Número de Utente) which is necessary for accessing public healthcare services. To register, you will need your passport, proof of your tax identification number (número de identificação fiscal or NIF), and your Portuguese residence permit. Regulations just changed this year that also require you to have a social security number (NISS) to obtain your Número de Utente and to be allocated a family doctor. If you have not yet had your appointment for residency in Portugal, you are able to apply for a provisionary Número de Utente.
The e-script program in Portugal is a very effective public program. There is an application that is very helpful to have on your mobile phone, it is called SNS24. This is helpful to keep your health records in one place, including your e-scripts from the public physician.
The public system covers primary care doctor visits, maternity care and birth, pediatric care, some dental treatments, mental wellness, chronic disease management, hospitalizations, prescriptions, and emergency services. The challenges within the public system are a lack of primary care physicians which result in longer wait times for general health appointments and an overcrowded hospital waiting room bogged down with patients who have non-emergent health issues. For this reason, many foreigners and Portuguese nationals are opting for private insurance to supplement their healthcare needs.

Private healthcare
The private sector in Portugal offers an alternative to the public system, characterized by reduced waiting times and a broad spectrum of medical specialists and services. Private hospitals, clinics, and diagnostic facilities offer modern infrastructure and a level of comfort that many people moving to Portugal from countries with well developed, modern healthcare systems may be accustomed to. To access private healthcare, immigrants typically need to pay out of pocket or purchase private health insurance. There are also health plans that are like a medical discount plan that usually will offer lower fees for medical visits, exams, and procedures for a monthly fee. This is not health insurance but can decrease the out-of-pocket expenses for those who do not have health insurance.
When purchasing health insurance, it is important to consider a few of the areas that may leave you surprised if you are not prepared. For example, you may need to pay up front at the private facility and then be reimbursed after submitting the receipt (fatura) to your health insurance company. You may also have a surprise if they do not reimburse you because they may not always give you comprehensive coverage. Many health insurance plans do not cover pre-existing conditions. Lastly, when you are arranging your health insurance, read the details of the cover carefully and compare different providers. Some will have a premium for people over 60 or 70, and some may not offer cover at all for older applicants. Even though you have been a loyal customer for many years, you may find that your existing provider will no longer offer coverage and you will need to rely on the public healthcare system and possibly utilize a discount health plan.
The next article will share information about how to use both the public and private systems to optimize your healthcare and more information about specific public and private healthcare facilities in and around Caldas Da Rainha and the services they provide.

Acknowledgements: Lucy Gray (Feature editor), Photo by Karolina Grabowska on Pexels ■