Portugal Targets Hospital Supply Costs to Curb SNS Debt and Waiting Lists

Portugal’s beleaguered public-health budget is about to meet a leaner diet. Prime Minister Luís Montenegro has put the sizeable invoice that hospitals and clinics present to the Treasury at the top of his agenda, promising to change the way the National Health Service (SNS) buys medicines, equipment and outsourced staff. In essence, Lisbon wants to pay suppliers sooner but, above all, to pay them less, insisting that the country can no longer accept the spiralling costs that have kept the sector in the red for much of the past decade.

Why the Government is chasing a slimmer invoice

Montenegro’s team points to €616 M in overdue bills that piled up by late summer as evidence that the old model is broken. Over three successive injections—€200 M in July, €500 M in October and a fresh €678 M in November—the government tried to extinguish the most urgent arrears, yet the headline debt number barely budged. Officials now say the obvious lesson is that cash infusions alone do not bend the curve. The cabinet therefore wants to imitate the early-2010s strategy of then-health minister Paulo Macedo, when rigorous price negotiations and a switch to generic drugs shaved hundreds of millions off the annual bill. The present plan goes further, promising to extend hard bargaining to medical devices, imaging services and even the short-term doctors hired through agencies.

Anatomy of the SNS debt mountain

When the pandemic crested in 2022 the SNS owed suppliers €2.3 B, the highest burden in eight years. A combination of extraordinary state transfers and slower pandemic spending reduced that figure to €1.087 B by the end of 2023, the smallest in a decade. Yet the respite proved temporary. By February 2025, the pharmaceutical lobby APIFARMA was again waiting on €403 M in late payments, and university economist Pedro Pita Barros calculated that hospitals were adding €26 M a month in fresh arrears during the first quarter. The recurring pattern—big bail-out, short-lived relief, renewed build-up—has convinced many analysts that the financing formula and procurement rules need an overhaul rather than periodic life support.

What new money is actually being injected?

This year’s total emergency top-ups, €1.378 B, are meant to shore up staff salaries, restore pharmacy shelves and allow oncology centres to restock cutting-edge therapies. The Finance Ministry argues that the transfers buy time for systemic fixes, among them an anti-fraud unit inside the SNS and a pledge to present an emergency overhaul plan before January. Even so, the ministry’s own projections show the health service finishing 2025 with a €1.352 B deficit, five times larger than the figure written into the State Budget last autumn. The mismatch underscores how higher-than-expected patient volumes, costlier new treatments and a lingering reliance on overtime have swallowed the allocated funds.

Hard questions from economists and industry

Hospital administrators, led by Xavier Barreto of the APDH, worry that across-the-board expenditure cuts could compromise care if activity levels keep climbing. Pharma executives echo that view, noting that the average payment period has ballooned to 170 days, almost triple the 60-day EU directive. Critics fear the government is aiming for a headline win—a lower gross spending figure—without building the sustainable funding base that universal care requires. Still, some fiscal hawks argue that sustained discipline, paired with real-time spending dashboards, can tame the debt if political resolve holds beyond the usual electoral cycle.

Will electronic invoicing help?

One fix already in motion is a mandatory e-invoicing platform, scheduled to encompass all public contracts by 2026 and to begin with hospital procurement next year. Health-sector suppliers will upload invoices to a centralised digital hub, giving auditors immediate visibility over quantities, discounts and payment deadlines. The government believes this transparency will deter duplicate orders, accelerate budget reconciliations and allow the Treasury to release funds as soon as a purchase is verified, thus shrinking the costly interest penalties for late payment. Montenegro’s aides hope that the system’s data-rich trail will also strengthen the nascent anti-fraud task force, making it harder for rogue actors to inflate prices or bill the state twice.

What it means for patients and taxpayers

For the public, the stakes are concrete. A more solvent SNS could reduce the risk of operating-room postponements, prevent the periodic shortages of cancer drugs and free up funds for hiring the family doctors still missing from many local health centres. For taxpayers, the promise is that every euro invested generates more health and less interest expense. Yet success hinges on two intangibles: the political discipline to keep future budgets realistic and the managerial courage to confront entrenched procurement habits. If Montenegro’s gambit works, Portugal may finally trade the cycle of debt for a cycle of value; if it falters, the SOS calls for fresh bail-outs will echo once again through São Bento.