Carcavelos, May 14, 2025 – Despite the increasing use of the private sector and its relevance as a choice for citizens, the National Health Service remains the cornerstone of the healthcare system in Portugal. This is one of the main findings revealed in the latest Policy Brief from the Health Expenditure Observatory: The relations between the public and private sectors in healthcare, conducted by researchers Carolina Santos and Pedro Pita Barros, holder of the BPI |'la Caixa' Foundation Chair in Health Economics, under the Social Equity Initiative, a partnership between the 'la Caixa' Foundation, BPI, and Nova School of Business & Economics.
The analysis aims to understand how the different components of the Portuguese healthcare system function and how responsibilities are shared among the State, families, and private entities. It focuses on two key aspects: the source of funds used to pay for healthcare (financing) and the providers of healthcare services (provision).
Financing: Public Sector Maintains Central Role, but Families Pay More
In Portugal, healthcare expenditure is still primarily financed through taxes, reflecting the National Health Service's role as a public insurer. In 2022, public insurance accounted for 55.37% of total healthcare funding—a slight drop from 58.62% in 2000. Meanwhile, out-of-pocket household spending increased from 24.98% in 2000 to 29.65% in 2022, indicating a rising direct financial burden on families. Public subsystems like ADSE saw their share drop from 6.27% to 3.02% over the same period.
Despite the growth of private health insurance, it remains a minor component in overall healthcare funding.
Service Provision: Private Sector Expands, but SNS Remains Pillar
On the service provision front, the private sector has seen increased utilization, reflecting demand for more diversity and speed in access. Nevertheless, data confirms that the National Health Service continues to be the system’s core, ensuring universality, equity, and solidarity.
Between 2013 and 2025, private sector usage rose from 7.61% to 15.34% of all recorded visits. After the pandemic, there was a progressive rebound in demand for private emergency services, culminating in a significant rise in private consultations in 2025. Yet, most people continue to rely on the National Health Service, often in conjunction with services like the SNS24 hotline, whose usage surged during and after the pandemic.
A System Evolving Yet Structurally Stable
The findings depict a healthcare system where the public sector remains central to treating illness, though it increasingly shares space with the private sector. This is true at both the aggregate level—looking at provider expenditures—and the individual level, through citizens’ care decisions.
Despite shifting usage patterns and private sector growth, the system has remained stable over the last 10–15 years, with public provision and reliance on the National Health Service still dominant.
The future of public-private collaboration will hinge on the ability to design public policies that acknowledge existing tensions and interdependencies, while upholding the fundamental principles of universality, equity, and solidarity that define the National Health Service.