According to the Performance and Impact Assessment Report of the Health System (RADIS), from the National Health Convention (CNS), in 2024, 58% of the population had some type of insurance, plan or subsystem, placing Portugal 25 percentage points above the European average.

The proportion of people with dual coverage grew from about 20% in 2012 to 35.4% in 2023, an increase of +15.2 percentage points, a figure surpassed only by Ireland (47%) in the European Union.

The report points out that this growing trend reflects “a progressive segmentation of access to care, with greater reliance on private insurance as a complement to the National Health Service (SNS).”

It cites co-payments, exclusions from the public healthcare system, pressure on waiting times, and commercial strategies of insurance companies as causes for this increase.

Demographic and social factors, such as aging, multimorbidity, greater health literacy, and the emphasis on speed and comfort, also reinforce this demand.

According to the document, “the pandemic acted as a catalyst, increasing the perception of vulnerability and stimulating adherence to insurance.”

The document warns that the phenomenon reflects “an adaptive response of families to the limitations of the SUS,” but raises challenges for equity and sustainability, namely the risk of deepening inequalities, erosion of trust, and the transfer of demand and professionals to the private sector.

The National Health Commission (CNS) argues that the strategy should balance the strengthening of the public sector with regulation and articulation with the private sector, “ensuring that coexistence does not compromise the principles of universality and prioritizes the interests and outcomes for the patient.”

Expenditure

The RADIS report also shows that per capita health expenditure in Portugal is almost 20% below the European average, despite having increased by approximately 5% between 2023 and 2024.

In 2024, per capita expenditure was €2,664.05, 4.8% more than in 2023, compared to the European average of €3,285, "placing Portugal 19% below the EU-27 average, still in a convergent direction, reducing its lag in relation to the others".

It points out that structural factors such as population aging, pressure on hospital care, and the need for investment in technology may explain the relative insufficiency of spending.

Among the causes cited are budgetary constraints, lower fiscal capacity, and priorities focused on cost containment, in a context of population aging and hospital pressure.