Portugal’s Emergency Room Visits Twice OECD Average Amid GP Shortages

Portugal’s hospital emergency departments are experiencing a level of traffic that dwarfs that of most developed nations. New data released by the Health Regulation Authority confirms what many residents already sense: a trip to A&E is now more common than a routine visit to the family doctor. The numbers tell a stark story—yet the underlying causes and the government’s strategy to reverse the trend are less widely understood.

Twice the Rush: Portugal’s Emergency Puzzle

An updated nationwide analysis shows 64 emergency-room episodes per 100 residents on the mainland last year—more than double the OECD average. Some independent public-health researchers place the figure even higher, pointing to studies that record above 70 contacts per 100 inhabitants when data from late 2024 are added. Regions such as the Alentejo and the Algarve top the chart, highlighting a sharp urban-rural divide. By comparison, the OECD benchmark of 26.6 visits offers sobering perspective: Portugal’s reliance on hospital doors as the first line of care is now the most pronounced among Europe’s medium-sized economies.

What Drives the Queue

Several forces converge to produce this surge. A shrinking pool of family physicians leaves roughly 1 in 5 residents without a fixed general practitioner, and older patients—Portugal is one of the most rapidly ageing societies in Europe—suffer multiple chronic illnesses that flare without warning. Equally influential is the ingrained belief that urgent care equals faster diagnostic tests; a CT scan obtained in hours rather than weeks is a potent lure. The regulator also notes a culture of self-referral: although dipping from 71.8% in 2022 to 64.4% in mid-2024, self-initiated episodes still dominate. Almost half of those visits are graded as “little” or “not” urgent, reinforcing the perception that the walk-in model remains hardwired in daily life.

Waiting-Room Reality

Long queues translate into stressful delays. Official Manchester-triage statistics show that only 44.4% of “very urgent” cases and 66.5% of “urgent” cases were seen on time last year. The wait is particularly acute after dusk and on winter weekends, when respiratory infections spike. Residents of Lisbon’s suburbs report routine waits that stretch beyond four hours, prompting some municipalities to organise their own transport to less congested facilities 60 km away. For frontline clinicians, the contradiction is clear: Portugal owns one of Western Europe’s densest emergency networks—89 hospital units at last count—yet capacity rarely matches demand when it matters most.

Government’s Winter Playbook

Hoping to keep corridors clear over the cold season, the Ministry of Health has rolled out a Seasonal Health Response Plan running through April. Measures include obligatory two-month rota publication for all Local Health Units, extended opening hours at primary-care centres, and activation of extra hospital beds for respiratory and chronic-care flair-ups. A revamped legal framework paves the way for regional emergency hubs, with Setúbal’s García de Orta Hospital slated to absorb obstetrics and gynaecology emergencies from neighbouring institutions early next year. To staff these efforts, up to 350 additional doctors may be hired on accelerated contracts, while a freshly minted anti-fraud commission—led by the Judiciary Police—polices overtime billing and manpower outsourcing.

Voices from the Frontline

Hospital directors and public-health scholars argue that the crisis is less about seasonal spikes and more about a systemic planning deficit. They call for a decisive upgrade of primary-care capacity, in particular an expansion of nurse-led acute clinics that can handle minor infections and injuries. The controversial but widespread use of freelance “tarefeiro” physicians remains a sticking point; veteran emergency chief João Varandas Fernandes argues that short-term contracts cannot be eliminated overnight without destabilising current rosters. Union data back him up: the Algarve alone is estimated to be short of 2,000 nurses, a gap that no temporary staffing agency can fully bridge.

Can Technology Tip the Scales

Digital solutions hold promise, though their impact remains largely theoretical. A new National Access System for Consultations and Surgery (SINACC), financed by the EU recovery fund, will let patients track their queue position online and even pick the hospital of their choice. Artificial-intelligence modules are being trained to flag which callers to SNS 24 should receive same-day primary-care slots rather than an A&E ticket. Telemedicine piloted in the Trás-os-Montes region already shows a 26% drop in non-urgent hospital contacts, according to internal ministry dashboards. Still, experts caution that without adequate broadband in interior districts and a rise in digital literacy among seniors, the technology promise could widen rather than close inequities.

What It Means for Residents

For people living in Portugal, the implications stretch beyond the inconvenience of a crowded waiting room. A health-care model skewed toward emergencies absorbs resources that might otherwise fund community-based prevention, from diabetic foot checks to mental-health counselling. In the short term, officials urge residents to dial SNS 24 or consult their local family doctor before turning to hospital doors; early data show the advice is slowly gaining traction. In the longer view, success will hinge on recalibrating public expectations, bolstering primary-care staffing, and ensuring that hospitals remain the place for genuine emergencies rather than the default entry point into the national health system.