Admiral Candidate Warns Expats Portugal's Public Health Under Strain

Foreign residents relying on Portugal’s public hospitals have just received a candid reminder: the country’s universal health model is entering a make-or-break phase. Presidential hopeful Henrique Gouveia e Melo has warned that the Serviço Nacional de Saúde (SNS) risks "going under" unless political leaders resist pushing core services into private hands. Money, he insists, is not the issue—organisation is.

Why newcomers should care about this fight

Portugal’s public network is the main gateway for residency visas, family doctors and emergency care. More than 80% of foreign nationals register with the SNS within their first year, partly because private insurance often requires an SNS number before coverage kicks in. If the public system weakens, expatriates could face longer waiting times for specialist consultations, higher co-payments in the private sector, and unpredictable rules when renewing residence permits that hinge on proof of health coverage.

What the admiral-turned-candidate actually said

Speaking outside Sintra’s new hospital on 24 July, Gouveia e Melo argued that the SNS remains "the only model capable of fighting inequalities and ensuring care for everyone." He stressed that state funding for health has doubled in 10 years, yet queues for first appointments have also ballooned to more than 900 000 patients. For him, the real culprit is "competition between models" that forces overstretched public units to chase the same staff and resources as profit-driven operators. While clarifying he is "not anti-private," he called the public pillar the system’s "anchor" and urged policy-makers "to stop sinking the ship that keeps us all afloat."

The tug-of-war over Portugal’s hospitals

Lisbon’s minority government recently relaunched public-private partnerships (PPPs) in five large hospitals—Braga, Loures, Vila Franca de Xira, Amadora-Sintra and Garcia de Orta—plus 174 associated primary-care centres. Supporters argue PPPs bring managerial know-how and capital; critics say they cherry-pick low-risk services and leave expensive chronic care to the SNS. The centre-right PSD backs wider PPP deployment, while the liberal party campaigns for full market opening. On the left, trade unions and the Bloco de Esquerda claim the plan is a "gradual privatisation" in disguise. This ideological gridlock helps explain why Portugal now spends €15.5 B on health but still reports the EU’s seventh-longest surgical waiting lists.

Money is not the only problem

Budget data for 2024 show a record €1.377 B deficit despite the biggest year-on-year injection of funds since the pandemic. Payroll costs rose 9.1%, supplier debt topped €1.4 B, and only 20 out of 52 entities paid their bills within the legal 60-day limit. Yet hospitals also performed a record 466 668 surgeries in six months, illustrating what experts call the "Red Queen" dilemma: the harder the SNS runs, the further it seems to fall behind. Gouveia e Melo points to fragmented chains of command, the slow rollout of Unidades Locais de Saúde—integrated local care hubs—and a shortage of digital tools linking hospitals to family doctors. "Fix the plumbing first," he summarised, "before arguing about which decorators to hire."

What happens next

If elected in January, the former navy chief says he will use the presidency’s soft power to push for a National Health Pact negotiated "in the privacy of offices" rather than public shouting matches. Constitutional lawyers note the head of state cannot dictate policy but can veto decrees, call referendums and convene experts at Belém Palace. Meanwhile, the Health Ministry has promised a €1.1 B boost in the 2025 budget and insists PPP contracts will include "strict public oversight". Final tender documents are due this autumn—just as the presidential race peaks—turning hospital governance into an unlikely election litmus test.

Takeaways for residents and would-be movers

For now, nothing changes in day-to-day access: you still register at your local Centro de Saúde and can use Urgências regardless of nationality status. But remember that over half of first-time hospital consultations already exceed legal wait limits, so booking early is key. Those weighing a move should factor in supplementary private insurance, which averages €40-€70 a month for adults under 60. Finally, keep an eye on the PPP rollout: if more hospitals switch to mixed management, billing procedures and international insurance acceptance may evolve rapidly. In a country celebrated for universalism, the coming months will show whether Portugal can preserve the SNS as its social bedrock—or chart a hybrid course that expats will need to navigate with care.