Healthcare in Portugal – As we wrapped up our third year in Portugal, my wife and I have had the chance to look back on some of the struggles we’ve endured and the triumphs we’ve achieved. In case this is your first time checking in with our time in Portugal, here are some of the highlights:

• October 2018: While living in Berlin, we took a trip to Portugal and fell in love with Porto.
• November 2019: We relocated to Porto and settled in Matosinhos, a seaside suburb.
• May 2020: After six months of some tough visa decisions and pandemic-related delays, we finally received our residence permits and began the clock on our temporary residency period in Portugal.
• May 2021: Despite more pandemic-related delays, we managed to get our residence permits renewed in time.
• December 2021: We moved to an apartment in downtown Porto after two years in Matosinhos and struggled with getting our security deposit back.

Just like any worthwhile odyssey should, our struggles with bureaucracy haven’t stopped there. In order to take advantage of Portugal’s public health system, we needed to accomplish a few things. We were registered in a health center in Matosinhos, but needed to relocate our care to downtown Porto to avoid an hour-long commute each way. As has been a recurring theme throughout our time in Portugal, we were swimming against the current when it comes to apathetic government workers, outdated or missing information, and the language barrier. This is the story of how my wife and I tried to transfer our healthcare to be closer to our new home in downtown Porto.

Understanding the Basics of Portugal’s Healthcare System

The guarantee of public healthcare in Portugal has been enshrined in the constitution since 1976 and is provided under the auspices of the National Health Service, or Serviço Nacional de Saúde (SNS). All citizens and residents are automatically given the right to healthcare from the SNS and some also supplement their public healthcare with private health insurance.

Although everyone legally residing in Portugal has the right to public healthcare, each person must be manually registered into the system according to their current place of residence. Each municipality has a local health center, or centro de saúde, that is responsible for all non-emergency healthcare for citizens and residents. When registered at the centro de saúde, you are given a user number, or número de utente, which allows you to make appointments and have the SNS cover your healthcare at hospitals and clinics.

LIke many other countries in Europe and around the world, Portugal is experiencing a shortage of doctors. As such, the SNS is understaffed at the local level and the wait for a Family Doctor can sometimes be quite long. Each doctor has a limited number of patients they can take on and there is often a waitlist in some municipalities that can take well over a year to get the first appointment. While this doesn’t affect emergencies or other urgent situations, it can be challenging to get convenient checkups or other doctor’s appointments when first moving to a new municipality in Portugal.

When not assigned to a family doctor at the local centro de saúde, you can only get a minimum level of services such as pregnancy consultations, urgent family planning, acute situations, renewal of temporary disability certificates, chronic prescription renewal, and vaccinations. All other services will only be available after being assigned a family doctor. In the meantime, some people may resort to paying extra at a private hospital or clinic.

Our Initial Experiences with Healthcare in Portugal

My wife and I started living in Portugal at the same time, but I needed to get my resident permit first so that my wife could get her residence permit through family reunification based on my permit. As a result, our residence permits arrived at separate times. After I received my residence permit in January 2020, I walked down the street to the centro de saúde in Matosinhos with our relocation services assistant. I was registered provisionally but was put on the waitlist to get assigned a doctor.

In May 2020, my wife received her residence permit. Since it was in the midst of the first wave of the pandemic and during a lockdown in Portugal, we didn’t try to go to the centro de saúde in person and tried to start her health system registration through email. It was a few weeks before we ever heard back, but luckily she received her número de utente without much back and forth. The representative then asked for my paperwork. Since I was already registered, I thought it was a little strange, but I sent my documents to her again. She sent back my número de utente, this time with an assigned family doctor! Even though everything seemed to shut down during the early stages of the pandemic, we were able to use this situation as a way to bypass the normally lengthy route to getting assigned a family doctor.

Relocating to Downtown Porto and Trying to Register Again

By the time we moved to downtown Porto, we were already living in Portugal for a little over two years. To get our family doctor switched to one based in our new neighborhood, we needed to update our números de utente to the new centro de saúde nearby. Sounds easy enough, right?

We set aside one weekday afternoon to go to the local centros de saúde nearest to our new apartment. The first three that we walked into all turned us away and we were getting pretty confused since we were already registered with the SNS and just needed to switch locations. We eventually discovered that we needed to register at the centro de saúde for our civil parish, or freguesia. The staff at the last centro de saúde we visited that day told us where we needed to go according to our freguesia, but we were exhausted and decided to stay registered in Matosinhos for the time being.

We knew at some point that this issue would come back to bite us, so a few months later, we decided to go to the correct centro de saúde in-person on a Friday afternoon around 5pm before they closed up for the week at 8pm. Expecting that it would just be a quick wait to update the documents, we didn’t think much of it. When we got to the office, the staff at the front counter told us that all the appointments were already filled for the day. She told us we would need to come in person when the doors opened at 8am to be able to get an appointment for later in the day. Even more annoyingly, it was the last Friday of the month. Apparently, the duties for new patient registrations rotated on a monthly basis around the district, so that meant that from the following Monday we would need to go to a completely different centro de saúde location just to update our registrations.

Now armed with this valuable knowledge, I cleared out sometime in my schedule the following week and decided to go alone. By the time I arrived at 8:15 that morning, I was stunned to find out that there were only a total of six available patient registration appointments each day and that there were only two slots left for the day! I quickly reserved the final two slots for 2:20 pm and 2:40 pm that afternoon.

We showed up for our appointments and were directed to the waiting room to sit until our number was called. After a short period, the administrative assistant called us in and pulled up our information. She told us we were already registered in Matosinhos and seemed to want to get rid of us. I explained that yes, we used to live there, but now we’re living in the freguesia nearby and that several locals had told us we should get our information updated. She let us know that if we changed the registration to the new centro de saúde, we would be put at the bottom of the waitlist for a new family doctor. We would have to wait for an assigned doctor all over again, and she made it very clear that there wouldn’t be a doctor available in our new freguesia for the foreseeable future. 

After confirming that there would be no issue if we kept the registration at our old Matosinhos centro de saúde even though we lived in Porto, we decided to do nothing. If we kept our registration in Matosinhos, we would keep our family doctor and our access to routine health services. Of course, we’d have to sacrifice the convenience of staying close to home for commuting at least an hour each way to go to the clinic, but at least we wouldn’t have to wait a few years for another family doctor assignment. The administrative assistant’s rationale made sense and we left feeling much more confident that we got the best possible result for our current situation in Portugal.

Distilling Information and Learning from Experience

In the end of our latest chapter in the saga of dealing with Portuguese bureaucracy, not much changed. We were led in circles by well-intentioned locals and ultimately decided not to update our health registration. Although the bureaucracy in Portugal can be endlessly infuriating, we did our best to follow the rules, which is all you can do at the end of the day. We were thankful to at least come away with a better understanding of how the Portuguese public healthcare system works.

Even though I’ve lived abroad since 2014 and have dealt with many similar situations before in various languages, it’s always still surprising and quite frustrating when you don’t know the whole picture. I couldn’t have gotten this far in Portugal or my own life abroad without consistently seeking help from relocation agencies, locals, and experienced expats.

I founded Expat Empire in 2018 to help expats avoid the same problems I’ve experienced and much more. We work with clients all around the world who want to move abroad, including many that are focused on Portugal. Our Consulting Services include 1-on-1 Coaching that can give you the inside scoop on the expat experience in Portugal and beyond. We will also connect you with our partners who can give you the hands-on help you need in expat destinations around the world. To get started, schedule your Free Consulting Call so we can get to know your situation and help you move abroad!