More than a third of Portuguese people (35.4%) have dual health coverage, with simultaneous access to the SNS and an insurance or subsystem – a figure three times higher than the European average (10.4%).
According to the Health System Performance and Impact Assessment Report (RADIS), from the National Health Convention (CNS), released this Wednesday, in 2024, 58% of the population had some type of insurance, plan or subsystem, which places Portugal 25 percentage points above the European average.
The proportion of people with double coverage grew from around 20% in 2012 to 35,4% em 2023an increase of +15.2 pp and a value that in the European Union is only surpassed by Ireland (47%).
The report points out that this growing trend reflects “a progressive segmentation of access to care, with greater use of private insurance as a complement to the SNS.
The causes for this increase include copayments, exclusions from the public basket, pressure on waiting times and commercial strategies of insurance companies.
Also demographic and social factors, such as aging, multimorbidity, greater health literacy, appreciation of speed and comfort reinforce this demand.
According to the document, “the pandemic acted as a catalystincreasing the perception of vulnerability and encouraging adherence to insurance”.
Response to a weak SNS
The document warns that the phenomenon reflects “an adaptive response by families to the limitations of the SNS”but it raises challenges for equity and sustainability, namely the risk of deepening inequalities, erosion of trust and the transfer of demand and professionals to private companies.
The CNS argues that the strategy must balance strengthening the public sector with regulation and articulation with the private sector“ensuring that coexistence does not compromise the principles of universality and puts the interests and results for the patient first”.
Still, Portuguese people spend little on health
RADIS also shows that the Health expenditure per inhabitant in Portugal is almost 20% below the European averagedespite having increased approximately 5% between 2023 and 2024.
In 2024, expenditure per inhabitant was 2,664.05 euros, 4.8% more than in 2023, compared to the European average of 3,285 euros, “putting Portugal 19% below the EU-27 average, yet in a convergent direction, reducing its lag compared to the others”.
It points out that structural factors such as population aging, pressure on hospital care and the need for investment in technology can explain the relative insufficiency of spending.
Among the causes cited are budgetary limitations, lower fiscal capacity and priorities focused on cost containmentin a context of population aging and hospital pressure.
