Medicine in Portugal: a brief look

Some of our U.S. friends are curious about health care costs and services in Portugal. Here is an overview of our experience during our first year.

Last year we paid 392 euros ($427) each month for top-tier health insurance. Yes, $218.50 each. Our plan covers medical consultation, treatments, and hospitalization through the private health care system. Our maximum co-pay was 18 euros per visit. Dental, vision, hearing, and prescription services are not covered. Next month we will downsize our plan, so our rate will decrease to about 350 euros per month. We find that we don’t need Lamborghini-level coverage.

“But don’t you get free public health care in Portugal?” Well, yes. And no.

Yes, as residents of Portugal, we qualify for free public health care. We have not yet been assigned a primary care physician at the local clinic due to doctor shortages in rural areas, so we cannot access the public health care system. Furthermore, because we have not been paying into the system through taxes, we don’t mind paying insurance premiums for private services. Soon we will pay income taxes for 2023, which was our first tax year. And, by the way, we will always pay annual income taxes to Uncle Sam. I will explain that interesting tax situation in another blog.

Emergency Services

In Portugal, all emergency medical services are provided at public hospitals and are free of charge to anyone -- tourist or resident -- including ambulance services.

Quality of Care

Let’s look at our experiences through 10 months of combined medical services:  3 evaluations with orthopedic specialists 20 or more physical therapy appointments 4 appointments with a cardiologist 3 appointments with a rheumatologist 4 appointments with a primary care physician 2 appointments with a dermatologist EKGs, ultrasounds, and other auxiliary services.

[Wow. With so many medical visits, one might be inclined to think we are knocking on Heaven’s door.  But, no, we are well and thriving!]

During all but one contact, we felt genuine caring attention from our providers. We never felt rushed. We felt human connection. We received excellent care. This description is repeated by every American I know here.

[photo from the internet]

How Does This Work?

How can health care providers be so attentive and so relaxed? Could it be their salaries?  Exploring data on incomes for doctors in Portugal, physician salaries here range from approximately 40,000 to 139,000 dollars a year -- comfortable but not rich – and less than half the average income of their colleagues in the U.S.

Maybe doctors in Portugal do not feel as much stress because they are not paying off massive debt from medical school. I was stunned to learn that medical students pay about 700 euros ($750) tuition per semester. Monthly living costs for students average 700 euros, bringing the annual total cost of medical school to 9800 euros ($10,486) per year!  

I am inclined to think that the high quality of medical care is more than the high quality of training. Patient-doctor relations reflect the cultural norms of a nation where relationships matter more than time or income. Keep in mind that this is a society where the national pastime -- meeting for coffee -- is really about engaging in conversation while sipping 2 ounces of espresso for 45 minutes.

High Quality, Moderate Costs

Over-all, health care costs are five times higher in the US per person than in Portugal, yet the care in Portugal is ranked among the top worldwide.  How can this be?

A Washington Post story a few months ago compared medical costs and practices in the US and Portugal. The story discussed Portugal’s greater focus on preventative care and integrated medicine. Doctors here spend much more time with each patient in evaluation, education, and follow-up than doctors in the US.  Surgeries and other costly interventions are implemented only if the less costly, patient-focused treatments have not yielded adequate improvement.

Meet You at the Dentist?

We do not pay for dental insurance. A recent first visit to a dentist included cleanings for both of us, exams, and 2 small fillings. The service was excellent. The facility is spacious, modern, and well-equipped. The total bill was 100 euros ($107) for both of us.

Hmm... perhaps some of you will combine your dental care with a visit to us! Until we see you at the dentist, Fica bem. Stay well.

And, as always, we love to hear from you! Tim and Penelope