This chapter covers the health care system in Portugal.

The Portuguese health care system is based on the National Health Service (SNS), which was founded in 1979.

The SNS includes all the official institutions and services that provide health care under the Ministry of Health, and the SNS has its own legal status.

The national network of healthcare covers SNS facilities, private institutions and independent professionals with whom contracts have been signed.

The SNS is characterised by:

• providing universal coverage;
• providing global health care in an integrated way or else guaranteeing its provision;
• usually being free to its users, taking into account the social and financial position of citizens;

• guaranteeing equal access to its users, with a view to mitigating the effect that economic, geographic or other inequalities have on access to health care;
• Regionalised organisation and decentralised and participative management

In what situation can I claim?

The following persons are entitled to SNS coverage:

• all Portuguese nationals;
• nationals of member states of the European Union, the European Economic Area and Switzerland in accordance with the EU regulations in place;
• foreign nationals residing in Portugal, subject to reciprocity;
• foreign nationals residing in Portugal within the framework of bilateral agreements;
• Citizens requesting asylum and refugee status;
• Stateless citizens residing in Portugal.

Foreign nationals who do not hold a residence permit or who are in an irregular situation with regard to the legislation in force have access to the SNS upon presentation of a document from the Junta de Frequesia (municipal administration) of their place of residence attesting that they have been residing in Portugal for more than 90 days.

In order to access the healthcare system, asylum seekers must be in possession of a certificate of asylum application or a valid temporary residence permit.

What conditions do I need to meet?

Both nationals and foreign nationals residing legally in Portugal must register with the healthcare centre at their place of residence, specifically with the family health unit (USF) or the personalised healthcare unit (UCSP).

Registration can be done directly and preferably with the USF or the UCSP, or at the citizens’ office of the union of healthcare centres (ACES) upon presentation of the following documents:

• identity document/citizen card (or other identification document);
• certificate of residence (for example a certificate of residence issued by the Junta de freguesia (municipal administration), a water, electricity or telephone bill, etc.);
• Residence permit, applicable to the registration of foreign nationals.

A co-payment is required for hospital emergencies, except in situations where the patient has been referred by the SNS beforehand or when emergency hospitalisation is necessary.

The co-payment is to be made  for additional diagnostic procedures carried out during emergency care, up to a maximum of € 40, except when the patient has been referred beforehand by the SNS.

The co-payment scheme distinguishes between exemption and payment waiver. The exemption gives the user the right not to pay any fees irrespective of the healthcare provided and the waiver relates only to certain specific health services (consultations and complementary measures prescribed in connection with them during the treatment and monitoring of oncological diseases).

Persons exempted from the co-payment are required to present documents verifying their situation.

The following persons are exempted from the co-payment:

1. women who have just given birth;
2. children under 18 years of age;
3. users demonstrating a degree of incapacity of 60% or more;
4. users in situations of proven economic; precariousness as well as dependent members of the household;
5. voluntary blood donors;
6. living donors of cells, tissue or organs;
7. firefighters;
8. transplant patients;
9. military and former military personnel with permanent disabilities arising from service in the armed forces;
10. Unemployed persons registered at the Job Centre receiving an unemployment benefit equal to or less than 1.5 of the IAS (Social Support Index), who themselves as well as their spouse or dependents cannot demonstrate the necessary resources as prescribed by law during a situation that is transitory or which has a duration of less than one year;
11. Young persons for whom a procedure to change their situation and protection status is presently being dealt with by a child and youth protection commission or a court, with a measure applied in the context of Article 35 of the law pertaining to the protection of children and youths in danger, adapted by law 147/99 of 1 September, amended by law 31/2003 of 22 September, and unable to demonstrate the necessary resources in any way;
12. Youths affected by a detention measure of their guardian, a protective custody measure in an educational centre or a custodial measure in a public or private institution, based on a decision rendered under the guardianship law regarding education, adapted by law 166/99 of 14 September, as amended by Law 4/2015 of 15 January, and unable to demonstrate the necessary resources in any way;
13. Youths in social accommodation facilities, either based on a judicial decision in the context of a civil guardianship procedure, under which the guardianship or the simple exercise of parental responsibilities is granted to the institution in which the minor is housed, and who are unable to demonstrate the necessary resources in any way
14. Asylum seekers and refugees as well as their spouses or equivalent and direct descendants.

Foreign nationals who do not hold a residence permit or who are in an irregular situation under current immigration legislation have access to the SNS but must pay for the expenses incurred, except for the provision of healthcare in situations referred to below upon presentation of a document from the Junta de Frequesia (municipal administration) of their place of residence attesting that they have resided in Portugal for more than 90 days:

• urgent and life-saving healthcare;
• communicable diseases which pose a danger or threat to public health (tuberculosis or AIDS, for example);
• Maternal, child and reproductive health care, in particular access to consultations regarding family planning, voluntary termination of pregnancy, support and monitoring of women during pregnancy, childbirth and care for new-borns;
• Healthcare for minors residing in Portugal in accordance with the legislative decree 67/2004 of 25 March;
• Vaccination in accordance with the current national vaccination programme;
• Citizens in situations of social exclusion or economic precariousness on the basis of the supporting documents issued by the competent entities.

Asylum seekers and citizens with the refugee status have free access to the healthcare system and must be in possession of a certificate of asylum application or a valid temporary residence permit

What am I entitled to and how can I claim?

Users of the healthcare services are entitled to

• Choose services and service providers, as far as existing resources allow;
• Decide to accept or reject any healthcare provision that is proposed to them, unless otherwise provided for specifically by law;
• Receive the healthcare needed, without delay or within a period of time considered clinically acceptable, when appropriate;
• Receive the most appropriate and technically suitable healthcare according to the rules of medical ethics;
• Be entitled to the protection of personal information and their private lives;
• to confidentiality of their personal information;
• Be informed about their situation, possible treatment options and how their state of health is likely to evolve;
• Receive religious support, whatever the religion they profess;
• Make a complaint about the way or file a claim with the health services, in accordance with the law, and receive compensation for any damage suffered;
• Appoint bodies to represent them and to defend their interests;
• to be accompanied at the SNS accident and emergency department;
• pregnant women who are in-patients at a health establishment have the right to be accompanied, through all phases of labour, by any person of their choice;
• Children who are inpatients at a health establishment have the right to be accompanied. This also applies to disabled persons, persons in a state of dependency, and persons with an incurable illness at an advanced stage or who are reaching the end of their lives.

Users of the health services must:

a) Respect the rights of other users as well as healthcare professionals;

b) Respect the rules governing the organisation and operation of healthcare services and establishments;

c) Collaborate with health professionals in relation to their own situation;

d) Pay the charges arising from the provision of healthcare services, as appropriate.

The Carta dos Direitos de Acesso [Charter on Access Rights] aims to guarantee the provision of healthcare services by the SNS and other approved providers within timeframes deemed clinically acceptable according to the state of health of each SNS user, as set out in this charter.

The Carta dos Direitos de Acesso [Charter on Access Rights] establishes:

a) The maximum guaranteed waiting times;

b) The right of users to information on these waiting times.

To guarantee this right to information, SNS establishments and approved healthcare providers are obliged to:

a) Affix, in an easily accessible place, up-to-date information on maximum guaranteed waiting times, organised by type of disease or groups of diseases, for the various types of healthcare services;

b) Inform the user at the time of making an appointment, by electronic means or by post, of what the maximum guaranteed waiting time is for the healthcare service that the user requires;

c) Inform the user, whenever it might be necessary to refer patients between SNS establishments, about the maximum guaranteed waiting time for the provision of the respective healthcare service at the establishment to which the patient is being referred, as provided for in the previous bullet point;

d) Inform the user whenever SNS establishments do not have sufficient capacity to meet these targets and it is necessary to refer the user to a private health establishment;

e) Ensure that their websites always have the latest information on maximum guaranteed waiting times for the various types of healthcare service;

f) Publish and circulate, before 31 March each year, a detailed report on access to their healthcare services; these services will be audited at random on an annual basis by the Inspeção-Geral das Atividades em Saúde [Inspectorate-General for Healthcare].

It is recognised that the user has the right to complain to the Entidade Reguladora da Saúde (ERS) [Health Regulatory Authority], in conformity with the relevant legal provisions, if the maximum guaranteed waiting times are not met.

With the transposition into Portuguese law of EU Directive 2011/24/UE, which concerns patients exercising their rights to healthcare across borders, and of EU Executive Directive 2012/52/UE, which sets out measures to facilitate and recognise medical prescriptions issued in another Member State, regulations governing access to cross-border healthcare and cooperation on cross-border healthcare within the EU have been established.

The SNS beneficiary may only access scheduled cross-border healthcare and, by extension, claim his or her right to reimbursement for healthcare services, by prior authorisation. Other healthcare services, although not dependent on prior authorisation for reimbursement, are subject to the rules defined by Law No. 52/2014 of 25 August. The request for prior authorisation requires a claim form to be submitted through the user portal.

As regards unscheduled healthcare, the European Health Insurance Card (EHIC) ensures access to this healthcare when beneficiaries of a social security system in one EU State or EEA State or in Switzerland travels temporarily to another country within this zone (for example, on holiday). The card guarantees the same access to state-provided healthcare as is afforded to citizens of the country being visited.

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Jargon busters

• National Health Service (SNS) : the SNS includes all the official institutions and services that provide healthcare under the Ministry of Health.
• Primary healthcare: care which represents the first level of contact between individuals, families and communities in the National Health Service, the Regional Health Service of the Autonomous Region of Madeira and the Autonomous Region of the Azores. This care includes the management of disease prevention and health promotion from a holistic perspective and based on community health, ongoing monitoring and, where appropriate, the use of specialised care.
• Secondary/hospital/specialist healthcare: care provided by hospitals. These establishments offer curative and rehabilitative care in a hospital or outpatient environment, and can contribute to disease prevention, education and scientific research.
• General hospitals are hospitals that offer a variety of services and specialised hospitals are hospitals in which there is a certain number of beds associated with a particular service or which provide assistance exclusively or particularly to persons of a certain age group.
• Emergency services: a functional clinical unit of a healthcare establishment which provides healthcare services to persons who have a sudden health problem or accident or whose health situation worsens at any time of the day or night for 24 hours.
• Co-payment: revenue for the National Healthcare Service applied directly to users and one of the measures governing the use of health services.

Forms you may need to fill in

• Residence permit for foreign nationals from third countries, issued by the Foreigners and Borders Service (SEF)];
• Residence permit for foreign nationals in an irregular situation issued by the Junta de Frequesia (municipal administration) of the place of residence;
• Residence card for EU citizens issued by the city council (Câmara Municipal) of the place of residence;
• Asylum application, submitted to the Foreigners and Borders Service;
• Application for refugee status submitted to the Foreigners and Borders Service
• Medical certificate attesting pregnancy;
• Multi-purpose medical certificate of incapacity (official template), which must be valid on the date when the incapacity is being assessed or re-assessed, and which confirms a degree of incapacity greater than 60%;
• Declaration of resources issued by the Centro de Emprego [Job Centre] on its template for purposes of registration.

Know your rights

The links below define your entitlements in accordance with Portuguese law. They are not European Commission links, nor do they represent the Commission's position.

• http://www.portaldocidadao.pt/;
• https://sns.gov.pt;
• www.acss.min-saude.pt/ ;https://www.sns.gov.pt/entidades-de-saude/secretaria-geral-do-ministerio-da-saude/;
• www.dgs.pt;
• Cartão Europeu de Seguro de Doença / information in English

Who do you need to contact?

Administração Central do Sistema de Saúde, IP
Parque de Saúde de Lisboa
Edificio 16

Avendia do Brasil, 53

1700-063 Lisboa
Portugal
Email: geral@acss.min-saude.pt
Website : www.acss.min-saude.pt/
Tel. +351 217925500
Fax +351 217925848