Do I need Health Insurance in Portugal?

crop nurse demonstrating small double colored pill

Wondering whether you need health insurance in Portugal? The answer is no.

Having health insurance in Portugal is completely optional. As a legal resident in Portugal, you are entitled to public healthcare, which is heavily subsidised by the government.

However, you are not limited to the care available within the public system, called Sistema Nacional de Saude (SNS), in Portuguese. You may choose to be looked after in a private hospital or clinic. In which case, you are required to either cover the full cost of treatment yourself or, to purchase health insurance, which will cover part of the cost. But why would you do that?

As a nurse trained by the Sistema Nacional de Saude (SNS) in Portugal, I will share insights on when private healthcare and health insurance may be beneficial. This blog post provides information to help you decide whether health insurance in Portugal is right for you. It’s important to note that I have no affiliations or incentives with any health insurance company and do not mention any company in this post. The information shared is solely based on my personal experience and knowledge.

When and Why Would You Choose Private Healthcare over Public?

You do not need to choose one over the other. If you are entitled to the SNS, this is great news. As a nurse trained in the Portuguese health system, I am glad to report that in general the standard of care is high. However, as you might well be aware, public health services have undergone huge pressures in the recent years, worldwide. And Portugal is certainly no exception. With that in mind, let’s see how public healthcare works in Portugal.

The Direção-Geral da Saúde (DGS) regulates the SNS which is organised into primary and secondary health care. You can find out more about this in our article “Healthcare in Ericeira- Public Services”.

In general, you would go to a primary care facility to see your family doctor for routine consultations and general care, such as immunisation and other common nursing procedures. Whereas hospitals provide specialist consultations, exams, and other more complex medical procedures.

Now, if you can afford private care, arguably, you would have the best of both worlds. That is because in Portugal, the private health sector plays both a supplementary and a complementary role to the SNS, as pointed out by this AM&A study.

The supplementary role would be when private hospitals offer advantages over their public counterparts, such as quicker access to care, more comfort, and the possibility of choosing your doctor.

Whereas the complementary service would be in those situations in which patients are forced to seek private care in order to fill in gaps in the SNS. These may be due to the nonexistence of certain services, such as dentistry; not having an allocated family doctor; the long waiting time for an specialist doctor’s appointment; or, long waiting lists for surgery. Let’s have a look at some of these situations in more depth.

Seeing a Specialist Doctor in the SNS

To see a specialist doctor in the SNS, your family doctor has to refer you. However, there may be two issues with this. Firstly, you may not have an allocated family doctor yet, as this can take years – you can find out how to apply for a family doctor at your local SNS health centre here. Secondly, the wait might be long and you may not be prepared to endure it. You can check the wait time for specialist consultations by hospital in this brilliant SNS page.

What if you can not or do not want to wait? There are two possible scenarios here. You either are seriously, acutely ill and are seen by a specialist doctor via an A&E department or, you go privately. And you can pay for this with or without insurance.

Seeing a Specialist Doctor Privately, With or Without Health Insurance

Now, say that like me, you did not want or could not wait to see a specialist, such as a gynaecologist. In that case, you would simply go online and select a hospital or clinic of your liking, as well as a doctor. You probably would not have to wait as long as in the SNS to see a specialist doctor.

Once at your gynaecologist’s consultation, as well as addressing your main concern and reason for your appointment, you may also have your echography and smear test done in one sitting. As well as that, you are likely to walk out of the door holding a prescription for all of the other age-appropriate screening procedures required. And research has shown that doing your check ups translate into better health outcomes, as we will see later.

Cost-wise, taking my case as an example, the gynaecology consultation plus eco and smear test would have cost me €215 in March 2023 in Lisbon. Instead, with insurance it came down to just under €50. For Insurance, I pay €80 monthly, which includes pregnancy and birth coverage. 

Moreover, most of the prescribed blood tests were done via the SNS, as my family doctor has approved them – I will tell you exactly how it works in a future article, if this is something you would be interested in. However, as some of the most expensive blood tests are not covered by the SNS nor by insurance, I have had to cover their full cost.

Now, let’s say you need surgery. How would you go about this?

Having a Surgery done in the SNS

Let’s ignore for a moment the shortage of family doctors and assume you have one. Now your family doctor has referred you for a common surgical procedure, such as a hip replacement. Your wait will depend on the severity of your problem, as well as on the availability of the service at the hospital. You can check the estimated wait surgery by specialty, severity and hospital in this SNS webpage.

You will be pleased to know that urgent surgery and cancer related surgery are dealt with swiftly. However, non urgent surgery often has waiting times that are longer than the maximum clinically recommended, which is 180 days.

According to CNN, one in five people currently waiting for surgery in the SNS have already passed that time limit – Orthopedy being the specialty with the greatest number of people waiting for surgery (oh-no!).

Looking at the public hospital where we would normally go while living in Ericeira, we can see that for a non-urgent orthopaedic surgery for instance, the current wait is 361 days. Whereas the wait for cancer and urgent orthopaedic surgeries are 22 and 79 days respectively.

Jorge Roque Cunha, president of the Doctor’s Association, regrets that many Portuguese have had no choice other than to go privately. There are currently 4 million people with private health insurance. The business has never been as strong as it is now, he points out. However, the SNS waiting list for surgery remains the longest seen in the last 25 years.

Having a Surgery done in the Private Health Care

It’s reasonable to assume that the wait for a non-urgent orthopaedic surgery in private healthcare would be shorter. Unfortunately, I don’t have access to that information as I haven’t been referred for a hip replacement myself. Similarly, the cost for private treatment is difficult to determine as private hospitals require a prescription with the specific type of treatment before producing a quote.

What we do know is that the cost of such a procedure will depend on various factors such as the technique and materials used, as well as the length of hospitalisation. For most modern procedures, the hospital stay usually ranges from 1 to 3 days. The cost of hospitalisation alone can reach €350 per day at one of Lisbon’s top private hospitals, excluding any treatment, procedure, or surgery costs.

When you’re contemplating opting for private healthcare and counting on insurance to assist with the expenses, it is crucial to remember that insurance companies require a waiting period for surgery and hospitalisation, such as this one, which typically lasts 12 months from the moment you sign the contract and activate the policy.

Does Having Health Insurance in Portugal Pay Off?

This is something to be considered according to each family’s situation.

For instance, you can ask yourself these questions: how often would you seek medical and dental care in a year? Do you require any heath-specific follow ups? Are you planning on having more children? Are you anticipating any major dental treatment? And so on.

Besides, you may find that your insurance does not cover some of the exams or treatment you need, anyway. Chances are that you may end up paying too much for insurance and not having as much back.

On the other hand, health insurance may help to improve your health and well-being. For instance, you may need healthcare more often than you would expect. And this could be more comfortably dealt with in private care with having health insurance. One can never know for sure.

Another benefit of having health insurance is that it may give you access to healthcare that you otherwise would not be able to afford privately. The alternative would be to wait for years in the SNS for procedures such as a non-urgent hip replacement for instance.

Moreover, with health insurance, especially if you do not have a family doctor, you may be more inclined to do your regular check-ups. And regular health check-ups, although not shown to make you live longer, have innumerous proven health benefits, as found in this metareview study published at JAMA in 2021.

The benefits of regular check-ups in populations at risk, include better detection and treatment of chronic illnesses such as depression and hypertension. Regular check-ups are also associated with an increase in vaccinations and screenings for diseases like cancer, as summarised by the Northwestern University Feinberg School of Medicine

If you are going ahead with health insurance in Portugal, there are a few things to keep in mind before you sign a contract

If you’re thinking of getting health insurance in Portugal, there are a few things you should keep in mind before signing up.

First, it’s important to know that there might be a waiting period before your insurance coverage kicks in for certain types of private medical care. This waiting period can be anywhere from 3 to 12 months, depending on the specific treatment you need.

Second, it’s important to carefully consider the different insurance options available and their terms and conditions. This will help you choose a plan that fits your health needs and budget.

Third, you should be aware of the co-payments and deductibles that come with your insurance plan. Co-payments are the costs you have to pay out of your own pocket for each medical visit or procedure, while deductibles are the amount of money you need to pay before your insurance coverage starts.

Fourth, you should check which healthcare providers are covered by your insurance plan. Some plans may restrict you to certain doctors and hospitals, while others offer more flexibility. You should consider your own healthcare needs and preferences when choosing a plan with a suitable network of providers.

Lastly, you should always read the fine print of the insurance policy and ask questions if there is anything you don’t understand. This will help you avoid any surprises and make sure you are fully informed before signing up.

In Conclusion, Do I Need Health Insurance in Portugal?

In conclusion, having health insurance in Portugal is completely optional as a legal resident, since public healthcare is heavily subsidised by the government. However, there are situations where private healthcare might come in handy, such as for quicker access to care, more comfort, and the possibility of choosing your doctor. Private healthcare can be used to complement gaps in the public system, such as waiting lists for surgery or non-existence of certain services. In those cases, one may choose to pay for private care with or without insurance. Ultimately, it is up to each individual to decide whether health insurance is a good idea based on their needs and preferences.

I would love to hear from you about your personal experiences with healthcare in Portugal, whether you have opted for health insurance or not. If you have any suggestions for future topics or would like to hear more about health-related issues in Ericeira and Portugal, please leave a comment below. Your feedback is important to us!

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