Healthcare in Portugal

Portugal has an improving standard of compulsory state funded free healthcare. The healthcare service in Portugal has long since struggled from the burden of under funding. Private healthcare operates alongside the state system. All employed citizens and their employers contribute to the social security fund. The Ministry of Health oversees the health service in the country.

The State System
The state healthcare service provides free or subsidised medical and dental treatment, including care and treatment by GPs and consultants, hospital care, laboratory services, subsidised prescription medicine, maternity care, surgical appliances and ambulance transportation.

Employers must register their employees with the Portuguese social security fund and make regular payments to the social security fund known as the segurança social. Dependant family members are covered by the contributions paid by employed family members. The unemployed, old age pensioners and people on long-term sickness benefit or maternity leave do not have to pay healthcare contributions. If you are self-employed, you need to get additional insurance to cover members of your family.

Foreigners immigrating to Portugal without jobs must produce proof of private health insurance in order to obtain their residence permit if they are not contributing to the social security fund. They also need to apply for a medical card from the local health centre, which proves your entitlement to free or subsidised care. You can only apply for this card once you have a residence permit and social security card, which you will be given at the time of your registration being accepted.

EU citizens who have paid continuous social security contributions in their home country for two full years before immigrating to Portugal are entitled to state healthcare for a limited period. You must prove that you have made continuous contributions by obtaining for E106 from your home social security authority. EU citizens and those from the European Economic Area (EEA) can make payments to their home countries social security systems and still use the Portuguese state system.  Again, you will need to obtain relevant forms proving payment back home.

People retiring to Portugal from other EU countries, who receive a state pension from their home country, and those who receive invalidity benefits have to get form E121 from their home social security authorities. This will then prove their entitlement to free care in Portugal. EU nationals who are of retirement age, but do not receive a state pension from their home country may still qualify for Portuguese state healthcare, but they will be means tested to prove that they can not afford to buy private health insurance.

Those in receipt of invalidity pensions or benefits should determine how their benefits would be affected by living in Portugal. Some countries have reciprocal agreements for invalidity rights, but they vary from country to country.

Once you are registered with the social security system, you will be issues with a social security card and a list of local GPs and hospitals, and information about services and fees.
There is a free telephone line (800 290 029) called the linha verde, which will provide additional information on specific cases. It operates from Monday to Friday from 9am to 7pm.

Fees
In Portugal, you must pay for any non-essential medicines. You must also pay between 40 percent and 100 percent of the cost of prescription medicine. Old age pensioners receive subsidised prescriptions. You must also contribute towards the cost of glasses, dentures, dental and spa treatment. Citizens who belong to vulnerable groups of society e.g. pregnant women, war veterans, diabetics and tuberculosis patients do not have to pay any charges. Appointments with a doctor and referrals to a consultant are free.

Private Healthcare
Many foreigners choose to take out private healthcare because of the inadequacy of the Portuguese state service. If you do not qualify for state cover, then you must have private health insurance to get your residence permit.

Private healthcare will also entitle you to faster access to consultant care and to private hospitals and clinics, which are substantially better equipped than those in the public sector. 

Portuguese insurance companies typically provide health cover for people under 55. Those over this age will have to obtain cover from a foreign insurer. You must also avoid insurance companies, who reserve the right to cancel your policy when you reach a particular age. Others may increase the amount you pay once you are over a certain age. 

Doctors and Health Centres
Doctors are the first point of contact with the Portuguese health system. Citizens can register with the doctor of their choice. However, people seeking state medical care must make sure that their doctor is contracted into the state system. If you are treated by anyone other than a state funded doctor, you will have to pay the fees yourself. When you visit the doctor, you need to present your medical card.

GPs prescribe drugs, treat acute and chronic illnesses, and provide preventive care and health education.

Health centres are known as centros de saúde. They are located in most areas of the country and are usually open from 8am to 8pm. Health centres only provide outpatient care but they do offer a wide variety of  specialist services. Medical services provided by health centres include general practice, maternity care, child healthcare and dental care. They also provide emergency medical aid as well as laboratory, radiology, and other diagnostic services.

Health centres are staffed by qualified doctors and nurses.

Consultants
Consultants are senior doctors who have completed a higher level of specialised training. GPs refer patients to a consultant if he believes that a patient may need specialist help and diagnosis. There are numerous specialist fields of medicine in Portugal like gynaecology, oncology, paediatrics and dermatology. There is often a long waiting list to see consultant doctors.

Hospitals
Hospitals and clinics exist in all major towns and cities of Portugal, but hospital facilities are inadequate in certain rural areas. Patients are admitted to hospital either through the emergency department or through a referral by their doctor. Once a patient is admitted treatment is controlled by one of the hospital doctors. The conditions in some hospitals are lacking. There may be a long waiting list for some non-emergency treatments and services. The state system provides only limited resources for outpatient treatment, nursing, post-operative care, geriatric assistance, terminal illnesses and psychiatric treatment.

Emergency Care
Emergency care is available free for everyone including those without state health insurance. However, once your condition is stabilised they will want proof of your insurance status. Emergency treatment is provided at the emergency room of all general hospitals and they are open non-stop all year. You may use their services if you need immediate attention, or if your GP refers you to them, or if there is no GP service available. There are some small British hospitals in the capital, Lisbon and in Porto.

Private Clinics
There are many private practices in the country provided by independent office-based doctors and specialists. The premises, equipment and personnel are funded by the doctors themselves. They are funded largely by private insurance contributions; many people use these facilities in preference to using the state service.

Dentists
Some dental treatment is available through the state healthcare system, but it only covers routine visits and check-ups. Citizens must pay themselves for more detailed dental treatment like crowns and bridges.

Pharmacies
Dispensing chemists known as farmácia de serviço sell medicines in Portugal. Farmácias are open during the working week from 9am to 1pm and 3pm to 7pm. On Saturdays they open from 9am to 1pm. Only doctors and consultants can prescribe medicine, but pharmacists are allowed to give advice and recommendations on the treatment of minor ailments. Non-prescription drugs are priced higher than prescription drugs. Under this system, you may pay less for a packet of aspirin if it has been prescribed by your doctor. Costs for prescription drugs are reimbursed through the state health system.

Outside of normal working hours, a duty chemist provides emergency prescriptions. The names of duty chemists is displayed in each chemist’s window and listed in the local press. You can also find out the name and address of your duty chemist by phoning 118.

More useful information available at www.seg-social.pt