One of the things that comes up when you're planning to move and live in Portugal is obviously the way the health system works. Portugal has access to a quality public health system (12th in the OECD ranking), but many expatriates are unaware of its functioning or have reservations about its effectiveness. The subject is even more important when there are children, pregnant women, elderly people and situations that require periodic monitoring or support, such as diabetes, for example. Therefore, in this article, Bob will try to clarify the main doubts and find out more about the subject. How to get healthcare in Portugal ? How much does it cost to access public healthcare ? Lisbob, the expatriate assistant in Portugal, tells you everything and offers you this complete guide to public health system in Portugal
The national health system in Portugal
The National Health System (NHS) is composed of local health units, groups of health centers and public hospitals. In general, health care is provided by health centers (centros de saúde) and their local branches. If you need an appointment with a specialist doctor practicing in a hospital, you will be given one within 72 hours.
In case of emergency, the patient can go to the nearest permanent care service (Serviço de Atendimento Permanente, SAP) or to the hospital. When the waiting period for admission to a hospital exceeds three months, the patient has the right to go to a private clinic approved by the Ministry of Health. Few people know it and do not benefit from it.
Health centers (centro de saúde) in Portugal
Health centers are responsible for providing basic and generalized care in situations where there is no great emergency. This is where routine consultations, nursing, family planning, child care and vaccination take place, among other things. This would be equivalent to neighborhood medicine centers in Europe. Each center has its own organisation in terms of services, but they all have one thing in common: there are no medical specialists. Medical treatments are provided by the family doctor, who will be assigned to you at the time of your registration at the health center, which is usually the closest to your home. This professional is a general practitioner and serves every family member who is also registered in the same center.
How to register at the health center (centro de saúde) in Portugal
Registration at the health center can be temporary (annual renewal) or for life, depending on your type of residence permit or visa. As a citizen of the European Union, you will not have to renew your registration at the health center. Once registered you will have a document called User Card that you will need to have with you whenever you need medical care. It is your identification at the NHS. To register, you must submit the following to the health center secretariat:
Identification document (passport, residence permit) ;
Proof of residence ;
Social Security Document.
If the patient has a specific problem, he or she will be examined by the family doctor (who assesses the need for further diagnosis and treatment) and referred to a specialist. The medical consultation by a specialist (paediatrician, ophthalmologist, cardiologist, urologist, gynecologist, dermatologist, etc.), which takes place in hospitals, must necessarily be prescribed by the health center and must be made at the address provided by the family doctor. In case of real emergency, the hospital is where you should go, without having to contact the health center.
Who has access to the public health system in Portugal
According to the Constitution of the Portuguese Republic, every person who requires medical care, being on Portuguese soil, is entitled to receive it. The Ministry of Health Decree n°360/2001 states that even illegal aliens in the country cannot be denied the access to medical treatment. Therefore, the information is very important and fundamental when you are in a foreign country. Understanding the system is the first step.
How much does a public consultation cost in Portugal?
The public health system in Portugal is not free, but it is much cheaper than a private service. Each consultation, whether at the health center or at the hospital, has a moderating rate. To get an idea of the values, a general medicine consultation currently costs €4.50, and a multipurpose emergency service costs €18.
However, there is a fee exemption in the following particular cases:
- Urgent and vital health care ;
- Communicable diseases which constitute a threat, or threat to public health (e.g. tuberculosis or AIDS) ;
- Maternal, child health care and reproductive health, including access to family planning counseling, voluntary abortion, follow-up and monitoring of pregnant women, childbirth and health care for newborns ;
- Health care for minors residing in Portugal, as defined in Legislative Decree n°67/2004 of March 25th ;
- Vaccination, according to the national vaccination program in force ;
- Foreign citizens in situations of family reunification, when someone in your household contributes to social security in a duly proven way ;
- Citizens in situation of social exclusion or in a situation of economic deprivation approved by the social security services.
How much does it cost to access care in Portugal?
It is necessary to pay a fixed share (nominal user fee) of the cost of most medical care, including for each consultation (health centers and hospitals) and each additional diagnostic examination. The health service will be in charge of other costs. However, many people are exempted from paying user fees. These categories include:
· Pregnant women who have just given birth ;
· Children up to 12 years old, people in economic need (whose income does not exceed 1.5 times the reference value of the social supports index: indexante dos apoios sociais, IAS) ;
· Unemployed people registered at the employment center and whose unemployment benefit does not exceed 1.5 times the value of the IAS, as well as and their spouses and children.
The patient will be exempted from paying user fees if the care is provided in a common ward of a hospital (or in a single room if recommended by the doctor). In case the patient freely decides to be hospitalised in a single room, the costs are borne exclusively by the beneficiary, as well as the costs of hospitals and private clinics. The payment of user fees varies according to the type of medical consultation, like consultation at home, normal or urgent consultation, consultation in a central or regional hospital, consultation in a health center. It may also depend on the type of auxiliary diagnostic and therapeutic elements. If you need dental care, you have free choice among private sector specialists. You will be refunded according to the scale set by the government. For dental prostheses, you will have to advance the fees and you will be refunded up to 75% of the prices set up according to the official scale. Medications prescribed by health care providers may be purchased at any pharmacy upon presentation of the medical prescription. Depending on the type of illness, the state can contribute from 15% to 90% on the drugs included on the official list of health services. Special rules apply to certain pensioners whose benefits are low. In this case, the government participation is increased by 5% and 15%, and some generic drugs are 100% state-refunded.
In regard to supplementary therapeutic equipment and prostheses (such as glasses), the health services are involved in the cost up to a determined ceiling which is based on the specified percentages and conditions. Spa treatments can be refunded according to the official fee after prior authorization. Travel costs can be covered for patients living in remote areas, under certain conditions.
The public health system in Portugal for pregnant women and babies
The NHS also provides specialized care for all pregnant women, regardless of their nationality, from confirmation of pregnancy to delivery and post-delivery. As demonstrated in the last article, women are exempted from paying restraint rates during up to 60 days after the baby is born. During this time, a review visit is planned to assess recovery. The new family member will not pay for any type of medical care until the age of 18.
Low-risk pregnancies are monitored at the health center by the family doctor himself. Pregnant woman may be followed-up or have occasional appointments at the health center’s maternity. This is also where periodic examinations and ultrasounds are performed. However, delivery does not have to take place in this health unit. In Portugal, women can choose any other mother-child center of the public network to be able to give birth.
In case of prematurity, some hospitals in the public network are even better known than private hospitals because they have neonatal intensive care with all the necessary equipment.
Have treatment in public or private in Portugal?
The public health system in Portugal is quite complete and effective. However, depending on the city and even the area of residence, not everyone has a family doctor, there are long waiting lists and going through the emergency square can be frustrating. The waiting period for a specialised consultation can take several months. There are also unsatisfied professionals, strikes and appointments canceled the same day or that have been "forgotten". In other words, it is not perfect. In addition, the reputation of some public hospitals in the big Portuguese cities is rather bad: the waiting hours are sometimes endless, and the conditions of hygiene are sometimes hint the acceptable boundaries. The choice between the public and the private depends on the assessment of your priorities and needs. Do I have a health problem that requires constant and personalised care? Am I ready to wait for weeks or months for a specialist consultation? Am I able to pay the costs of a private health plan? Whoever answered yes to these questions will probably prefer to resort to the private system, but always knowing that this is an option which is obviously more expensive.
Some information is taken from the site http://ec.europa.eu