The Portuguese healthcare system is currently in turmoil, characterized by the closure of Accident & Emergency (A&E) departments, a critical shortage of healthcare professionals, and alarmingly long waiting times for patients seeking medical attention. This situation has left many questioning the management capabilities of the National Health Service (SNS) and the government’s response to the escalating crisis.
Management challenges and competition with the private sector
Pedro Pita Barros, a noted expert in health economics, emphasizes that the root of the SNS’s issues lies not only in its management capabilities but also in the fierce competition posed by the private healthcare sector. He points out that private institutions have demonstrated greater efficiency in recruitment and retention of staff, leading to disparities in patient care quality. Barros states, “To a certain extent it’s management too, but to a certain extent it’s competition with the private sector. It’s much more capable of working well in terms of recruitment and retention, of paying more attention to people. So we have two big tension points here, pure and hard management and a human resources issue. These will perhaps be the biggest challenges over the next three years.”
In response to the crisis, the government unveiled a Health Emergency and Transformation Plan in May 2024, aimed at ensuring universal access to healthcare. However, the plan has not yet yielded significant improvements. During a parliamentary debate last week, the Prime Minister acknowledged continued dissatisfaction with the SNS’s performance, citing instances where patients faced waiting times exceeding 30 hours.
User experiences and dissatisfaction
Barros remains cautiously optimistic, urging that the plan evolve from an emergency response into a sustainable improvement strategy. He underscores the importance of continuous adaptation of the SNS to meet emerging healthcare needs. “We have to get away from the idea that we’re going to be able to solve the problems of the National Health Service in a month or two. The problem isn’t making rules or yet another law to transform the national health service. The question isn’t whether we’re going to have a date when we reform the SNS, the question is how we can permanently adjust the national health service to the needs that arise,” he elaborates.
Many patients have expressed frustration with the current system, particularly regarding mandatory pre-screening via telephone before accessing emergency services. This requirement has been criticized for further delaying the provision of urgent medical care. One user recounted, “Just last week, with a relative of mine who was referred to the emergency room by Saúde 24, we were there for almost 12 hours. And as far as I can tell, I don’t think it was too bad. There were cases of patients who had been there since the night before.”
The Movement of Public Service Users (MUSP) has publicly stated that the Ministry of Health is aware that long waiting times stem from a shortage of skilled professionals and inadequate conditions to retain and attract them. MUSP criticized the government’s bureaucratic response, which included hiring a health call center, claiming it only adds another layer of delay to an already serious problem that requires substantial investment in the SNS and its workforce.
A recent report by the German pharmaceutical company Stada indicates a significant decline in satisfaction with public healthcare across Europe—from 74 percent in 2020 to just 56 percent in 2024. Alarmingly, only 49 percent of Portuguese respondents expressed satisfaction with the SNS’s response to their healthcare needs. In the Euro Health Consumer Index, Portugal ranks 13th out of 35 European countries, trailing behind nations like Switzerland, the Netherlands, Norway, and Denmark.
The Health Minister has acknowledged the “unacceptable” nature of prolonged waiting times in emergency services and has promised forthcoming actions to address these challenges. Despite repeated inquiries regarding additional measures under consideration, the Ministry has yet to provide further details.