Portugal's Tribunal de Contas has issued a scathing audit of the Lisboa 65+ health program, determining that the flagship initiative from Lisbon Mayor Carlos Moedas failed to deliver meaningful benefits to elderly residents while spending nearly as much on publicity and legal advice as on actual medical care.
Why This Matters
• €289,542 went to advertising and legal fees — almost matching the €292,424 spent on health services
• Only 12% of eligible Lisbon residents (15,293 out of 130,000) enrolled in the program since its 2022 launch
• Ambulance hospital transport — a heavily promoted feature — recorded zero usage over four years
• Opposition parties are now demanding accountability and integration with Portugal's national health system (SNS)
What Went Wrong
The audit, released by the national Court of Auditors, concluded that Lisboa 65+ was "redundant and inefficient," failing to provide value beyond services already offered by Santa Casa da Misericórdia de Lisboa and the Portuguese National Health Service (SNS). The program promised free 24-hour medical access for Lisbon residents aged 65 and older, including telemedicine, home visits, dental care, ophthalmology, and ambulance services.
But utilization remained dismal. Telemedicine and home medical visits reached just 21% of contracted capacity, dental services hit 11%, and eye care scraped by at 5%. The ambulance-to-hospital transport — a centerpiece of Mayor Moedas' October 2022 announcement — was never used once.
The Tribunal de Contas highlighted that a substantial portion of resources was absorbed by "instrumental components or contracted capacity that did not translate proportionally into actual health care delivered." In other words: the city paid for services few residents wanted or knew how to access.
The Cost-Benefit Imbalance
Lisbon's municipal government allocated an estimated €1.5M annually for the program between 2023 and 2025. Yet the audit revealed that graphic design, public relations campaigns, and legal opinions consumed roughly half the total expenditure — nearly matching what went toward treating patients.
For residents already navigating Portugal's complex public health bureaucracy, Lisboa 65+ added another parallel system with no interoperability. The Court of Auditors noted the absence of a consistent public accountability framework, meaning Lisbon taxpayers had little visibility into how their money was being spent.
The tribunal attributed the failure to "structural inadequacies in the program's design, initial conceptual flaws, governance weaknesses, poor information flow, inadequate monitoring, and the municipality's limited institutional maturity in managing health contracting."
Political Fallout and Accountability Demands
Opposition parties seized on the audit's findings. The Socialist Party (PS) announced it will table a formal recommendation in Lisbon's Municipal Assembly demanding that Mayor Moedas' administration provide a full accounting of Lisboa 65+, disclose the current status of all contracts, present detailed physical and financial execution data, and outline corrective measures in response to the audit.
The Bloco de Esquerda (BE) — which had warned of these exact problems when the program launched — said the audit vindicates its longstanding criticism. BE councillor Carolina Serrão submitted a formal inquiry to Mayor Moedas demanding explanations, an assumption of political responsibility, and a commitment that any future reform "must necessarily pass through integration with the SNS."
In a statement, the BE argued that "without effective integration into the National Health Service, the program became an expensive communication policy with weak practical execution and limited impact on the lives of elderly people." The party had proposed SNS coordination in 2022 — including shared access to patient medical histories and continuity of care — but Mayor Moedas' administration rejected the idea.
What This Means for Residents
For Lisbon's elderly population, Lisboa 65+ represents a missed opportunity. Rather than bolstering the overstretched SNS or coordinating with existing municipal and charitable services, the program created a fragmented, underused alternative that drained public funds without measurable health outcomes.
The Tribunal de Contas urged future municipal health initiatives to ensure they are "genuinely complementary" to SNS care and existing social services, and that municipal departments possess the technical capacity and expertise required for complex health interventions.
Other Portuguese municipalities have taken different approaches. Oeiras, for example, implemented a medication co-payment subsidy that reduces pharmacy costs for economically vulnerable seniors by 50%, while Maia expanded its Municipal Senior Health Program to 3,000 older adults with regular weekly or biweekly activities focused on physical exercise and cognitive training. These programs prioritize prevention, social inclusion, and coordination rather than creating parallel structures.
The Broader Context
Portugal's aging demographic makes municipal elder-care programs increasingly urgent. Yet Lisboa 65+ illustrates the risks of prioritizing visibility over functionality. The audit's revelation that publicity spending rivaled health service delivery highlights a design flaw: the program was conceived more as a political branding exercise than a needs-based intervention.
The Court of Auditors also pointed out that Lisboa 65+ lacked the kind of routine performance reporting that would allow residents to assess whether their tax money was being well spent. Transparency and accountability — hallmarks of effective public health governance — were absent.
What Happens Next
The PS and BE are pushing for answers in Lisbon's Municipal Assembly. Both parties want Mayor Moedas to clarify whether Lisboa 65+ will be reformed, scrapped, or integrated into the SNS framework. The audit recommends that future programs be built on rigorous needs assessments, coordination with existing providers, and ongoing monitoring systems that can quickly identify and correct inefficiencies.
For residents currently enrolled in Lisboa 65+, the immediate impact remains unclear. The city has not yet announced whether services will continue, be restructured, or phased out. Elderly Lisbon residents seeking health support may be better served by exploring SNS primary care units, Santa Casa da Misericórdia Lisboa programs, or the Serviço de Apoio Domiciliário (SAD) offered through social security and municipal partnerships.
The Lisboa 65+ case serves as a cautionary tale for municipalities across Portugal: well-intentioned programs require solid planning, realistic execution, and meaningful integration with national infrastructure. Without those elements, public money flows into underused services that fail the very people they were designed to help.
