If you’re dreaming of retirement in Portugal, you’re not alone. This small European country is hugely popular with expats. It’s hard to imagine anyone who wouldn’t love Portugal’s warm climate (averaging 59 degrees Fahrenheit in January!) low cost of living, and overall high quality of life and healthcare.
Just how high is that quality of healthcare? According to the 2019 Health Care Index, Portugal’s healthcare system ranks 22nd out of 89 countries and earns particularly good marks for quality of infrastructure. A different study by the World Health Organization rated Portugal 12th in the world in terms of overall healthcare efficiency. And, in 2018, the Euro Health Consumer Index ranked the Portuguese healthcare system as the 13th best in Europe. Contributing to these high results are strong rankings in privacy, patient rights, accessibility, and short waiting times. And there’s no arguing with the outcome. Portuguese people enjoy an average life expectancy of 82 years.
If you’re planning to retire to this sunny destination, this is what you need to know about healthcare in Portugal.
Portugal Has A Three-Stream System
Portugal’s public health coverage is divided into three streams of care. The first is the National Health Services or NHS (or, as it’s known in Portuguese, the SNS.) In operation since 1979, the NHS is overseen by the Ministry of Health and serves all people who contribute to the social security system. (However, it only covers mainland Portugal. The Azores and Madeira operate their own healthcare systems.) The NHS is funded through general taxation and social security contributions. Those who aren’t in the workforce, like children and retirees, are exempt from making contributions.
The second stream is known as the health subsystem program. It provides health insurance to members of certain professions and organizations. Some of the most prominent groups include the police, the military, banking services, and public servants.
The third stream of care is voluntary private healthcare. While not as popular as it is in other countries, private healthcare still plays an important role in Portuguese society. There are a number of national health insurance providers as well as international companies that serve the expat community. Names you might hear include Multicare, AdvanceCare, and Medis.
Portuguese Healthcare Costs Are Very Reasonable
NHS services include everything from GP services and maternity care to hospital treatments and community healthcare programs. These are funded through general taxation and are further subsidized by worker contributions via the social security system.
Portuguese residents have to pay a small portion of their medical costs, usually amounting to a few euros per consultation. This includes a small contribution to the cost of doctor and specialist visits, hospital care, and prescriptions. It also includes most dental care costs. However, there are exceptions for members of the population who are from low earning groups.
For the uninsured, basic healthcare costs in Portugal are reasonable. The cost of seeing a general practitioner is usually less than 60 euros. Basic dental cleaning starts at about 25 euros.
Private Health Insurance Isn’t That Common
Private health insurance is much less common in Portugal than it is in other European countries. Approximately 20 percent of residents carry some kind of private health coverage. Having private insurance means that you can be seen in private hospitals and clinics, where wait times are generally reduced. As well, private facilities offer a greater degree of comfort and patient privacy. Plus, if these patients do use public facilities, their modest co-pay will be reimbursed by their private insurance provider.
Some Expats Are Already Covered By Portugal’s Healthcare System
Many expats are automatically eligible for healthcare coverage in Portugal. If they are European Union citizens, they can access public healthcare through the European Health Insurance Card. This free card — which you must apply for before leaving your home country — entitles you to receive healthcare in Portugal at the same costs and standards as local citizens.
Secondly, expats from several non-EU countries have reciprocal healthcare agreements with Portugal. This list includes Andorra, Brazil, Cape Verde, and Morocco. As such, they can use the public healthcare system in Portugal for little to no cost.
All Expats Are Eligible For Care
Finally, all permanent residents in Portugal qualify to use the public healthcare system. While this doesn’t help short-term residents or tourists — who should all carry travel medical insurance for visiting Portugal — it does mean that those who have relocated to Portugal long-term are eligible for care. As in most countries, there’s a fair bit of paperwork involved in the process but it isn’t overly complicated.
You Need To Have Insurance To Get Insurance
The first step to getting health coverage in Portugal is to have health coverage! It sounds like circular logic, but in order to get a residency permit (an essential component for anyone looking to enroll in the public healthcare system), would-be expats must demonstrate that they already carry private medical insurance. The thinking behind this is that expats should not be a burden to the state by arriving ill or not having adequate coverage to provide for their care should they fall ill.
The process of obtaining a residency permit can be expedited by visiting a local Junta de Freguesia office, which will issue a certificate confirming you have more than 90 days of residency in Portugal.
Signing Up Is (Relatively) Easy
The next step for expats is to obtain a Portuguese número de contribuinte, the equivalent of a social security number. Employers usually do this on behalf of their employees but self-employed individuals will need to do it on their own.
With your social security number and residency permit in hand, you head to your local health services center. Once there, you fill out an application and receive your healthcare card, necessary for accessing the public healthcare system.
Care Is Clinic-Based
The starting point for all health appointments in Portugal is a community health center — the same health centers you visit to first obtain a health card. All family physicians operate through local health centers. Expats can visit the SNS website to find the location closest to them. The community health centers also provide maternity and childcare services, non-emergency care, and sometimes additional services like dental and physiotherapy care. A health center visit is necessary to be referred for specialist appointments.
However, some forms of routine care may take place at a local hospital, depending on how things are set up regionally. For instance, many prenatal care appointments take place within the hospital system.
Mental Healthcare Services Are Poor
Portugal’s healthcare system has many strengths, but providing mental health services isn’t one of them. There are only about 12 psychiatrists per every 100,000 inhabitants. Compounding this shortage is the fact that an estimated 30 percent of the Portuguese population has experienced some form of mental health struggle. The country also has higher than average levels of depression and substance abuse (though the latter is improving).
To access mental healthcare in Portugal, you first have to visit your GP. They’re able to prescribe medication, refer you for counseling, or refer you to a specialist.
Pro Tip: Understanding The “Social Hospital”
One of the most unique things about Portugal’s healthcare system is the “social hospital.” These are hospitals that were once run by private institutions focused on social solidarity. These institutions were primarily the misericórdias, a name that translates to “holy houses of mercy.” Historically, the misericórdias, which date to the late 1400s, were the main hospital care providers in Portugal. Today, they have an agreement with the National Health Service. They are publicly subsidized and offer services much in the same way as public hospitals.
Editor’s Note: The info about Portugal’s climate shared in the first paragraph of this article is from weatherspark.com.