Portugal's Lab Test Surge Strains Budget, New Controls Ahead

Blood tests, biopsies and other routine lab exams cost the state more in 2024 than the year before, halting a short-lived downswing and raising new questions about how Portugal pays for diagnostics. After a dramatic contraction in 2023, the public bill has crept upward again, and it is Portuguese taxpayers—already wrestling with higher energy and mortgage costs—who ultimately underwrite the difference.

A rebound that masks a wild ride

The official ledger closed at €244 million, a 4.1 % increase on the previous year and the second-largest item in the SNS convention network after radiology. This rebound represents only a fraction of the volatility seen since the laboratory diagnostics boom triggered by the pandemic. In 2021, fuelled by the COVID-19 testing boom, expenses peaked at €378 million before plunging by more than a third in 2023. Economists read the oscillation as a warning: the state still lacks a stable financing model for routine diagnostics, even after the public accounts were supposedly re-balanced. The Entidade Reguladora da Saúde confirms a higher volume of requisitions per capita, suggesting that 2024’s rise is demand-led rather than price-driven.

Demand drivers: demographics, doctors and delayed check-ups

Several converging trends sit behind the uptick. An ageing population with chronic conditions, an influx of 1.5 million foreign residents, and a wave of post-pandemic catch-up appointments are keeping laboratories busy. Primary-care bottlenecks make hospital labs overflow, while specialist referrals for oncology and metabolic disorders have multiplied as wider screening protocols come into force. Growing consumer expectation of rapid results pushes family doctors to outsource to private laboratories instead of queuing within the public service. The result is an ever-thicker stack of vouchers paid at convention rates.

Regional map: North surges, Center and Algarve accelerate

Territory matters. Lisboa e Vale do Tejo still absorbs the lion’s share of absolute spending, yet its outlay fell fractionally in 2024. By contrast, the North registered a 3.6 % rise in the North, driven by a 15 % leap in requisitions per thousand inhabitants. The Center posted 13.7 % higher spending in the Center, while the Algarve’s 7.8 % jump and Alentejo’s 6.2 % reflect expanding private coverage in areas once served by public hospitals alone. Analysts note that population density effect and the long transport distances to public labs outside metropolitan hubs tilt decisions toward private providers.

Market concentration sets alarm bells ringing

Behind the aggregate numbers lies a concentrated industry. Just three dominant operators handled roughly 55 % of requisitions, with Grupo Germano de Sousa and SYNLAB topping the list. The competition watchdog warns that such pricing power could hamper the state’s negotiation leverage and erode the viability of small local labs that often serve interior regions. Patients see little difference at the counter because the tests are reimbursed, but concentration could distort investment decisions and reduce redundancy in crisis times.

Counting the cost for the public purse

The latest figures push total SNS expenditure to total SNS outlays of €15.6 B, and diagnostics claim an ever-larger diagnostic wedge of that sum. Finance officials fret about shrinking fiscal room for prevention and mental-health programmes if lab costs keep climbing without delivering better value for money. Auditors point to unnecessary tests and opaque doctor-lab relationships that still escape scrutiny. Plans for digital prescriptions and tighter audit mechanisms exist on paper but lag in execution.

What policymakers plan next

A 2025 Health Ministry review aims to publish a new reimbursement table tying prices to clinical relevance. Pilots of AI-based auditing will mine prescriptions for anomalies, while standardised clinical pathways should limit redundant requests. A forthcoming data transparency law will require providers to disclose quarterly revenue from state-funded tests, and intensified Court of Auditors scrutiny will extend to regional health administrations. By adding quality indicators and real-time patient-level costing, officials hope to cut waste without slowing access—a delicate balance that Portuguese residents will be watching closely.