Access to healthcare for the population is a central goal of health systems and a fundamental pillar for equity. This report, based on a representative sample of residents aged 15 or older in mainland Portugal, analyzes the evolution of access to healthcare in the country between 2013 and 2025. Focusing on the decisions made by citizens from the moment they feel ill, the report identifies significant inequalities associated with socioeconomic, demographic, and geographic factors, which undermine equity in the healthcare system.
As in previous years, socioeconomic inequalities in health and access to healthcare are evident in the occurrence of episodes of illness. In fact, individuals in the most disadvantaged economic bracket are 67% likely to report at least one episode of illness, compared to only 39% among individuals in the most advantaged brackets. In 2025, financial barriers to healthcare remain high, above the levels observed in the pre-pandemic period (2013–2019) and during the most intense phase of the pandemic (2020–2021).
Although between 2022 and 2025 there was a substantial drop in the percentage of respondents who use healthcare solely in the public sector – National Health Service (SNS) – 83.52% of respondents contacted only the SNS during their last episode of illness. In the public sector, the most frequently sought services are primary healthcare. Even so, the coverage of the population by family doctors in the SNS remains low.
One point worth highlighting is the reduction in demand for public hospital emergency services, which seems to reflect the introduction of the “Call first, save lives” program, an initiative that seeks to promote pre-triage through the SNS 24 hotline before resorting to hospital emergency services. The majority (61.9%) of people who have called the SNS 24 line were satisfied or very satisfied with the recommendations provided. Evidence also suggests that the possibility for individuals to issue a self-declaration of illness is also contributing to a more efficient use of SNS resources.
Finally, since treatment and care are not limited to the clinical response to illness, but involve recognizing the uniqueness of each person, their subjective experience, and the context in which they live, it is important to note that the population's levels of satisfaction with the humanization of care provided in the health system—SNS, for-profit private sector, and non-profit private sector—remain below those recorded in the pandemic and pre-pandemic periods.
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Authors of the study: Pedro Pita Barros and Carolina Borges da Cunha Santos.
This report is part of the Social Equity Initiative , a partnership between FundaciĆ³n "la Caixa" , BancoBPI, and Nova School of Business and Economics.