Record Health Spending in Portugal: What Expats Need to Know

Portugal’s struggle to keep its public health system both generous and solvent is entering a decisive phase. Fresh Eurostat figures show that the country now devotes 10 % of national output—roughly €29 B—to healthcare, a share that puts Lisbon in the upper third of the EU league table. Yet that headline masks fast-rising costs, a decade of uneven investment and a 2025 budget that tries to reconcile promises of better care with a record deficit.

A mounting bill in an ageing nation

Spending on hospitals, primary care and medicines has climbed steadily since the financial crisis. Between 2013 and 2023 the ratio of outlays to GDP moved from 9.7 % to 10 %, occasionally spiking above 11 % during the pandemic years. Over the same span, the cash total jumped from about €18 B to almost €29 B, reflecting not only inflation but also Portugal’s rapidly greying population. Demographers warn that by 2030 one in three residents could be over 65, a trend that exerts extra pressure on the Serviço Nacional de Saúde (SNS).

Continental context: who spends what

When EU finance ministers compare notes, four countries dominate the scoreboard. Germany tops the chart with €528 B in 2023, followed by France on €325 B, Italy with €179 B and Spain on €138 B. Portugal’s €29 B looks modest beside those giants, but relative to national wealth the Portuguese effort equals the bloc average and exceeds the commitments of Luxembourg, Romania, Hungary and Ireland, all of which channel under 7 % of GDP into health. In fact, only Germany and France break the 11 % threshold that Portuguese planners briefly reached in 2021, the worst year of COVID-19.

Reforms, pay rises and digital bets

The government’s 2024 overhaul dissolved the Administrações Regionais de Saúde and created Unidades Locais de Saúde, a move billed as a route to faster decision-making but one that immediately lifted payroll costs. The 2025 draft budget sets aside an extra €425 M for salaries, taking the wage bill to €7.09 B, while a parallel push for electronic health records and remote monitoring is meant to squeeze efficiencies from day-to-day operations. Around half of next year’s allocation—€8.35 B—will still go to buying goods and services, and capital investment, largely funded through the EU’s Recovery and Resilience Plan, will rise to €578 M. Despite the injections, the SNS ended 2024 with a €1.38 B deficit, the largest on record, and officials concede that a shortfall of roughly €217 M will linger in 2025.

Value for money: the per-capita lens

Measured per resident, the Portuguese spend about €2 664 of public money and just over €4 500 in total outlays on health each year. That figure trails the €6 200 mark recorded in Germany and the €4 865 level in France but is higher than the latest figures available for Spain and on par with Italy. Outcomes paint a mixed picture. Life expectancy, at 82.5 years, beats the OECD mean, and cancer screening programmes enjoy strong uptake. Yet hospital waiting lists remain long, family-doctor coverage is uneven and thirty-day mortality after heart attacks and strokes still exceeds the European norm. Analysts often cite Portugal’s high medicine consumption and comparatively low consultation rates as signs that resources are not always channelled to the most cost-effective interventions.

What comes next for taxpayers and patients

Preliminary Finance Ministry tables suggest health could absorb 13.3 % of all primary public expenditure in 2025, its highest share in a generation. Officials hope that contracting more services from the private and social sectors, expanding hospital-at-home schemes and accelerating approvals for generic and biosimilar drugs will curb the trend. Critics, however, point to persistent supplier arrears, under-execution of capital budgets and the absence of a clear roadmap for balancing books once EU pandemic funds dry up. For households, the immediate question is whether the additional billions will shorten queues and improve outcomes before another flu season tests the system again.