Portugal’s Parliament has given its initial approval to proposals tightening the rules governing access to the National Health Service (SNS) for foreigners who do not live in the country, including measures requiring payment for treatment or proof that healthcare costs are covered.
MPs on Friday approved, in general terms, a joint PSD/CDS-PP bill and a ‘p+8fseparate Chega proposal addressing healthcare provided to non-resident foreigners. The legislation must still go through the parliamentary committee process before a final vote.
The PSD/CDS-PP proposal would apply to foreign citizens who are not resident in Portugal or are staying in the country irregularly, requiring them either to pay for healthcare received through the SNS or provide proof of insurance or another entity responsible for covering the cost.
It also seeks to strengthen procedures for identifying who is liable for payment and recovering amounts owed, including, where considered necessary, the possibility of advance payment, a guarantee or another mechanism to secure payment.
Urgent care would remain protected. Patients requiring urgent treatment would be attended first, with proof of coverage and other documentation provided afterwards.
The bill was approved by PSD, CDS-PP and Chega, while PS, Iniciativa Liberal, Livre, PCP, BE, PAN and JPP voted against.
Algarve debts helped drive proposal
An audit by Portugal’s Health Activities Inspectorate-General (IGAS) found that €1,234,358 in invoices issued for emergency treatment provided to non-resident foreigners in the Algarve during 2023 and 2024 remained unpaid.
Over the same period, the number of non-resident foreign patients attending Algarve emergency departments rose from 17,736 to 19,111 – an increase of 7.8%.
Norte, whom PSD Algarve described as a co-author of the proposal, argued at the time that the figures showed the issue was particularly relevant in a tourism-dependent region.
“In the Algarve, more than €1.2 million outstanding shows that this is not an abstract debate. We are a tourist region, open to the world and receiving millions of visitors.”
He stressed that the proposal did not necessarily mean patients would have to pay personally, as responsibility could lie with an insurer, another country or another legally responsible entity.
Chega bill also approved
A separate Chega proposal was also approved.
If enforced, it would establish that non-resident citizens from outside the European Union, stateless people, applicants for international protection whose cases have not yet been approved and migrants without regularised status can use the SNS subject to payment for services provided, while retaining access in medical emergencies.
That bill received support from PSD, CDS-PP, Chega and JPP, with the remaining parties voting against.
However, Parliament rejected another Chega proposal which went further by requiring non-resident foreigners to pay the full cost of treatment when discharged and extending co-payments to some pregnant women without resident status and asylum seekers awaiting decisions.
Opposition calls for better collection instead
The issue has divided Parliament over whether Portugal needs stricter access rules or simply better enforcement of payment mechanisms already available.
During Thursday’s debate, PS argued that existing legislation already establishes payment responsibilities for people who are not resident in Portugal and accused the right of presenting foreigners as responsible for wider problems affecting the SNS. PSD and CDS-PP countered that the existing system has failed to ensure that money owed is actually recovered.
A non-binding PS resolution approved on Friday asks the government to establish how many non-resident foreigners use the SNS, what treatment they receive, which coverage arrangements apply and what costs ultimately fall on the health service.
It also calls for an assessment of existing identification, billing and debt-collection procedures, with findings presented to Parliament within 90 days.
An IL recommendation was also approved, calling for payment to be collected before treatment where patients themselves are responsible for the cost, or alternatively for an initial deposit to be requested.
The approved legislation now moves forward for detailed consideration before returning to Parliament for a final vote.
Source: Lusa