1.3 Million Patients Waiting for Care: Portugal's Healthcare System Faces Crisis Over Fragmented Records and Medicine Shortages

Portugal's National Health Service is struggling under the weight of 1.3 M people awaiting care, medication shortages, and a fragmented record system that forces patients to repeat exams and travel long distances for hospital prescriptions—a crisis that a coalition of 86 patient advocacy groups is now calling a matter of "social and territorial justice."

The Plataforma Saúde em Diálogo, representing patient, consumer, and health promotion associations across Portugal, released a comprehensive assessment of the country's health system that outlines five urgent failures requiring immediate structural intervention. The coalition's president, Jaime Melancia, warns that prolonged wait times combined with medication supply disruptions are undermining treatment effectiveness, disease control, and citizen confidence in the SNS (Serviço Nacional de Saúde).

Why This Matters

• Over 1M patients are waiting for specialist consultations and another 264,615 for surgery as of late 2025, creating treatment delays that worsen chronic conditions.

• The absence of a unified health record forces redundant testing, delays diagnosis, and increases clinical risk—especially for those managing long-term illnesses.

• Only 1,380 patients currently access hospital prescriptions through local pharmacies, despite an estimated 150,000 to 200,000 eligible for the program, forcing costly and time-consuming hospital trips.

• Medication shortages are affecting treatment availability across the SNS, with particular impact on cancer patients and those managing chronic conditions requiring specialized therapies.

The Record-Keeping Gap Driving Inefficiency

At the heart of the coalition's demands is the implementation of a fully interoperable unified health record system. Currently, Portugal's primary care clinics, hospitals, social services, pharmacies, and private providers operate on disconnected platforms, creating what Melancia describes as "information fragmentation" that generates duplicate exams, delays clinical decisions, and heightens risk for chronic disease patients.

The coalition argues that a centralized electronic health record (RSEu) would reduce costs by eliminating redundant diagnostic procedures, improve care continuity across providers, and create a national database for evidence-based health policy. The Serviços Partilhados do Ministério da Saúde (SPMS) is coordinating the implementation, with 2026 positioned as a decisive year for consolidating integrated care and aligning with the European Health Data Space (EEDS) regulation.

Initial implementation guides for sharing vaccination records, allergies, and intolerances were under public consultation in mid-2024, with the broader rollout designed to meet the EU's March 2029 deadline for cross-border exchange of patient summaries and electronic prescriptions.

Medicine Shortages Affecting Patient Care

The SNS faces an escalating medication crisis. Hospital pharmacies are reporting shortages that force patients—particularly those with oncology and inflammatory bowel disease—to postpone scheduled treatments or purchase drugs out-of-pocket at community pharmacies. The Infarmed (National Authority for Medicines and Health Products) has implemented measures to manage critical shortages and maintain supply of essential medications.

The root causes of shortages are complex: international manufacturing disruptions, budget constraints, logistics bottlenecks, and commercial non-viability for certain low-margin generics. Geopolitical tensions have destabilized global pharmaceutical supply chains, while delays in public procurement tenders compound the problem.

What This Means for Residents

For anyone living in Portugal and relying on the SNS, these systemic failures translate into concrete inconveniences and health risks. Chronic disease patients—those managing diabetes, heart conditions, autoimmune disorders, or cancer—face the greatest vulnerability. Without a unified record, each new provider lacks visibility into prior treatments, test results, or medication histories, forcing patients to repeat diagnostic procedures and delaying therapeutic decisions.

The pharmacy dispensing program illustrates the coalition's justice argument. Currently, hospital patients can theoretically collect specialized medications at local pharmacies under a proximity dispensing program. In practice, fewer than 1,400 people access this service, leaving tens of thousands to travel long distances to hospital pharmacies, often requiring time off work and imposing transportation costs that strain household budgets. For rural residents or those with mobility limitations, these trips become significant barriers to treatment adherence.

Regional Disparities and the Justice Argument

The coalition emphasizes that current inequities are not merely administrative inconveniences but violations of territorial justice. Patients in remote or underserved regions face compounded disadvantages: longer travel for hospital pharmacies, fewer specialists to manage chronic conditions, and limited access to specialized therapies due to regional variations in availability.

Melancia's framing of pharmacy dispensing as a justice issue reflects broader frustration among patient advocates that policy implementation lags far behind legislative intent. The program exists on paper but serves fewer than 1% of its potential beneficiaries, perpetuating a two-tier system where urban residents with access to multiple hospitals enjoy practical advantages over rural counterparts.

Five Priority Demands from Patient Advocates

The Plataforma Saúde em Diálogo framed its assessment around five structural weaknesses that demand coordinated government action:

1. Unified health record deployment: Full interoperability across all care levels aligned with EEDS requirements.

2. Medication supply stability: Structural reforms to prevent shortages through improved procurement planning and strategic approaches to maintaining supply of essential medications.

3. Pharmacy dispensing expansion: Scale the hospital medication dispensing program from 1,380 beneficiaries to the estimated 150,000–200,000 eligible patients, enabling local pharmacy pickup instead of hospital trips.

4. Accelerated access to innovation: Streamline regulatory and reimbursement processes to improve patient access to new therapies.

5. National guidelines for biologic medications: Establish uniform access standards to eliminate hospital-by-hospital disparities in which biologic therapies are available, ensuring geographic equity.

A System Under Strain

The coalition's assessment underscores a paradox: Portugal operates a universal healthcare system with strong legislative foundations, yet implementation gaps and resource constraints prevent millions from accessing timely, integrated care. The fragmented record system, medication shortages, pharmacy dispensing underutilization, and regional disparities form a web of inefficiencies that chronic patients navigate daily.

For residents, the practical takeaway is that advocacy and awareness matter. Understanding eligibility for pharmacy dispensing and documenting care delays for advocacy purposes can help individuals navigate the current system while pressuring policymakers for reform.

The Plataforma Saúde em Diálogo has positioned 2026 as a critical juncture—either the year that interoperability, supply stability, and equitable access begin to materialize, or the moment when systemic fragility hardens into entrenched dysfunction. For the 1.3 M people on waiting lists, the distinction is more than theoretical.