Political Pressure Mounts for Overhaul of Portugal’s Public Health System amid Soaring Waiting Lists

From north to south, the familiar red-brick façades of Portugal’s health centres are showing their age. In Parliament, the Liberal Initiative (IL) argues that the cracks are no longer cosmetic: according to the party, the Serviço Nacional de Saúde (SNS) is facing a “total and absolute breakdown” that can no longer be mended with quick fixes. Behind the rhetoric lie soaring waiting lists, a record financial shortfall and a migration of doctors to the private sector. Lisbon’s governing majority replies that emergency measures are already in motion, yet opinion polls suggest most families still worry about reaching a specialist in time.

Liberal Initiative raises the volume

IL’s health spokesperson Mariana Leitão chose unusually stark language this autumn, telling MPs the country had entered “the equivalent of a hospital code black”. The party insists that Portuguese taxpayers are paying more than ever for a system delivering longer delays, fewer professionals in public clinics, and mounting overtime bills for locum staff. Leitão’s colleague Mário Amorim Lopes brands recent budget injections “patchwork” because, in his view, they preserve a centralised model incapable of adapting to demographic change. IL’s strategy has proved politically useful: a recent University of Aveiro survey found that 90 % of respondents perceive a decline in health-care quality, and the party’s blunt diagnosis echoes that sentiment.

The numbers that fuel the debate

Official dashboards show why the word crisis resonates. By mid-year, 974 770 patients were still waiting for a first hospital consultation, more than half beyond the legally mandated response time. The cardiology queue alone swelled by 141 % in twelve months, and calls to the SNS 24 hotline now take an average of eight minutes to be answered—five times slower than last year. At the same time, the service reported a €1.377 B deficit, the largest in its history, even after the post-pandemic surge in funding. Economists at NOVA IMS warn that productivity has fallen for the third consecutive year, a trend they say threatens “system-level sustainability” if unaddressed.

Government points to incremental gains

Health Minister Ana Paula Martins concedes that the budget cannot expand “indefinitely” but rejects the apocalypse narrative. She highlights that in 2024 hospitals performed 9.1 % more surgeries, while the number of citizens without a family doctor dropped below 1.5 M for the first time in a decade. The ministry’s Programa de Emergência e Transformação da Saúde has already completed 63 % of its 54 measures, ranging from telemedicine pilots to new Local Health Units that merge primary and secondary care. In urgent care, self-referral fell and triage compliance improved slightly, though both remain below European averages. The minister argues that these are “green shoots” proving the model can still deliver if given time.

What a Liberal remake would look like

IL’s blueprint, dubbed SUA-Saúde, would pivot from the current monopoly approach to a universal purchasing model. Funding would stay public, but patients could take the State’s money to any qualified provider—public, private or social. The party also wants a new independent regulator with powers over clinical quality and competition, hospital boards selected strictly on merit-based criteria, and full real-time transparency of performance data. To stem the exodus of nurses and junior doctors, IL proposes flexible contracts, advanced practice pathways, and direct payroll autonomy for hospital managers. Public-private partnerships, once controversial, would return “wherever they outperform State-run units, under robust oversight,” according to the draft law IL announced for 2026.

Voices from corridors and waiting rooms

Inside São João hospital in Porto, senior surgeon Clara Abreu describes operating theatres running until midnight to clear cancer backlogs. She supports any plan that secures “predictable funding and motivated staff,” whether the badge on the door is public or private. In Setúbal, pensioner José Martins says his heart-valve appointment has been rescheduled twice; he doubts structural reforms will arrive before he does. Meanwhile, medical union FNAM warns that without pay comparability to Spain or France, Portugal will “continue to export its graduates,” leaving emergency departments dependent on agency contracts that already consume hundreds of millions of euros annually.

Why the stakes feel higher in Portugal

Unlike many EU neighbours, Portuguese households lean heavily on emergency care: in 2023 there were 64 urgent episodes per 100 inhabitants, more than double the OECD norm. Analysts link this to gaps in primary care coverage and the country’s high burden of chronic illness, from 930 000 diabetes cases to one of Europe’s fastest-ageing populations. As a result, incremental slips in response times translate quickly into existential fear among families, feeding the political salience of IL’s “rutura” narrative.

What comes next

Parliament will debate the next multi-year health-care framework in early spring. Government hopes that a slimmer deficit and gradual digitalisation will buy breathing room. IL intends to force votes on its autonomy, choice and transparency package, betting that the electorate is ready for disruptive change. For the 10.5 M citizens registered with the SNS—and the additional half-million who joined private insurance in the past decade—the outcome will determine whether Portugal’s cherished but strained universal system can be renovated or whether, as IL warns, a more radical rebuild is inevitable.