Should a public health system finance homeopathy

Health system in Portugal

Portugal's historic achievement is the security of its residents that they can call on a doctor at any time, regardless of their living conditions. You can find out here what this healthcare system looks like and which stumbling blocks it has to deal with. For you as a tourist, we have also posted a checklist if you need to see a doctor yourself on vacation.
The healthcare system in Portugal is among the best in the world (© Aleksandar Mijatovic / Adobe Stock)

»Saúde! To your health! «- the relationship between the Portuguese and the doctor

The state side - an economical further development

The national health service of Portugal ranks 12th according to the WHO. Its free access for all Portuguese to basic health services and operations in public health facilities is unique - apart from small co-payments and deductibles. Patients can also take advantage of subsidies for medicines, dentures, glasses and cures. Health care such as vaccinations has improved in recent years.

Its disadvantage is the long waiting times for operations without an urgent need and specialist treatments. Some of these restrictions, as well as inadequate care for cancer patients, result from the time of the debt crisis (2011–2014). However, postoperative care, nursing and psychiatric care have evolved little by little. State health expenditure per capita increased from 2015 to 2017: from 2,400 to 2,600 euros (source: wko.at). The main reasons are the increase in the number of computer tomographs (CT) and magnetic resonance tomographs (MRT), the increase in operations and higher drug costs. The government saves in secret and limits expenses on running costs.

The level of medical care in Portugal is 3.33 doctors per 1,000 inhabitants compared to 3.73 in Germany. Private health care providers are getting better and better at getting a piece of the big cake. After all, the life expectancy of Portuguese people at birth is high. In 2017 it was 85 years for women and 79 years for men - compared to 83 years for German women and 79 years for German men (source: WKO). There is always more to heal and care for.

The desired reinvestments are a development problem. The state spends around 100,000 euros on medical studies and between 200,000 and 400,000 euros in specialist training. However, fewer graduates are finding vacancies in public service than would like; the offer is not big enough. The competition is the right - the private health centers, which score points with their applicants with their modern equipment and reasonable payment.

Trends on the patient side

From the citizens' point of view, the trend towards private supplementary insurance is increasing. This means that they can also have consultations with a private doctor. They like to benefit from faster appointments than they are used to from their health center, the »Centro de Saúde«. In mid-February 2019, the strike of the state operating theater nurses burst into this situation, which posed challenges for the patients who were waiting anyway. While part of the nurses maintained an emergency plan for urgent operations, the other part drew attention to the low starting salaries.

Well-trained nurses looking for work

Graduates from the tax-financed Nursing College Coimbra start their careers with a charge of 5,500 euros in tuition fees (as of 2019). Their pluses are the bachelor's and master's degrees for nurses compared to German nurses. Every year around 380 graduates from the oldest Portuguese nursing academy, founded in 1881: "Escola Superior de Enfermagem".

Expecting a bright future, however, it is noticeable that a medical project assistant (MTA) in Lisbon currently earns an average of 20,000 euros gross per year, with five years of professional experience and an age of 30. A registered nurse earns an average of 18,000 euros annually - at ten years of age Professional experience, age 35, married and with two children (source: medinside.ch).

Salaries are one side of the coin. The other is that two thirds of the graduates cannot find a job in their home country. In 2015, 2,768 nurses and 707 doctors went abroad. Where was the rest? The people then have the choice to work as bogus self-employed with a collective wage. Perhaps under these conditions they end up with the state health service or in a private clinic. Or they hire out with a temporary employment agency. To put the picture into perspective, it should be added that the Portuguese, compared to their German colleagues, spend around 20 percent less on the standard of living. The rents can also be cheaper with 250-650 euros net rent for two rooms outside the city center.

What is important to doctors in Portugal or: with specialist training in a simple hospital?

A Lisbon general practitioner can expect an average of 26,000 euros gross per year in a public hospital, with ten years of professional experience, aged 35-40, married and the father of two children. One may suspect altruistic or social reasons if an applicant does not focus on the well-equipped private clinics. The fact is that the underfunding and quality reduction in the state health facilities have made them less attractive. This was an advantage for the new 1,900 foreign doctors, for whom these positions were in great demand (as of 2015). And that's good.

Development result

Since 1988, the state polyclinics in Portugal, similar to Germany, have focused on business efficiency and profitability. A significant step in development after the end of the last review was the personnel adjustments to the 35-hour week, which initially went hand in hand with increased recruitment. Their capping led to a new shortage of staff. It is one of the factors that mean that public institutions can only meet a third of the need for medical services.

Checklist for your doctor's visit in Portugal

To the doctor or wait until after the vacation?

Basically, you make a decision as to whether an illness or injury will heal on its own, for example a bee sting or sunburn. Treatment can often wait until after your vacation when you are back in Germany. This can be with a broken tooth corner that you feel no pain and with which you can continue to eat temporarily. As you can see below, your choice has an impact: on the reimbursement of costs and the waiting times on site.

Which health insurance pays for what on my vacation in Portugal?

As a legally insured person, unplanned to see a doctor

On the back of your German insurance card you will find the EHIC - the "European Health Insurance Card". Have them ready along with your ID card and the English or Spanish language names for your symptoms.

In a state health center (Centro de Saúde) or the emergency room of a public hospital (hospitales públicos com urgência) you will receive so-called medically necessary and immediately necessary treatments. Your temporary stay in Portugal can usually be a maximum of six weeks per calendar year. After completing a form, you will now receive basic outpatient care with medication and aids or partial services for an inpatient stay. The doctor bills your health insurance company directly.

If you have problems accepting the EHIC, explain the costs and submit the invoices to your health insurance company for reimbursement. Find out from your health insurance company which treatment data it needs for reimbursement. The standard for the Portuguese in Portugal is the standard for the amount of repayments.

The treatment of chronic illnesses and preventive examinations are not insured. You also have to pay privately for a visit to a specialist doctor in a public hospital, a private doctor, a private hospital and the return transport to Germany in the event of illness. Usually such costs are due immediately. You should clarify planned medical treatment on vacation in Portugal, such as dialysis, with your health insurance company beforehand.

As a privately insured person - civil servant, employee with high income, company owner or self-employed

As a privately insured person, you will continue to be insured through your health insurance company during your first month in another European country and have recently provided evidence of this with the "Certificate of Entitlement". You can get it on the pkv.de website. Whether a medically necessary return transport to Germany is also insured depends on your contract.

Expect the following cash outlays: at the dentist around 40 euros per treatment hour, at a doctor around 60-90 euros - plus the costs for x-rays, materials and medication.

As the holder of annual travel health insurance - for a short time

Additional travel health insurance for a trip of up to six weeks is recommended for all of the above costs that your health insurance company will not reimburse. There are very inexpensive insurances such as that of ERGO, from 10 euros per year. A patient repatriation and an emergency call service are included.

It is advisable to compare the insurance benefits offered with your security needs, for example: Should a return flight be insured in the event of a medical emergency or not? It makes sense to check the exact wording of what is offered, for example the distinction between: “absolutely necessary” treatments or repatriation and “medically sensible”. The insurance policies are usually extended from year to year without notice.

As a long-term vacationer, intern or student

For one year or up to five years abroad in a row, you are insured with international travel health insurance such as that from STA Travel from 34 euros per month or HanseMerkur. It is basic insurance for medical emergencies abroad. If you return earlier, you can have the difference reimbursed.

Before treatment in Portugal: clarify how the costs will be covered

Your international travel health insurance usually requests information by telephone BEFORE your treatment - even if the costs are low.

If you have to deal with larger sums of money with any health insurance, ask whether you should interpret the costs or whether there can be direct cost processing with the hospital, for example for operations. In the event of a postponement, clarify with your statutory health insurer what part of the private costs it will cover. You will need a cost estimate from a specialist or private doctor.

Contacts:

How the healthcare system in Portugal is structured

Portugal has private hospitals (hospitales particulares) and public hospitals (hospitales públicos). The best care in Portugal is offered by all private hospitals and public clinics in the following places: Lisbon, Faro, Porto, Évora and Portimão.

The public hospitals belong to the SNS, the public health system in Portugal (Serviço Nacional de Saúde) with three pillars: the health centers in the regions (Centros de Saúde), the public clinics in different legal forms and the local health stations (Unidades locais de Saúde).

The Centros de Saúde are not hospitals, but facilities comparable to a general practitioner. As a tourist, they will issue you with referrals to a hospital or a specialist. Clinicas are often a name for small groups of general practitioners or dentists.

There are also professional health service providers. In addition, around a third of the Portuguese are inclined to natural medicine or alternative medicine. Natural food stores in the large shopping centers as well as the hip shopping streets offer what osteopaths, healers and service providers recommend for acupuncture, fascia treatment and homeopathy.

Health tips for you as a tourist in Portugal

Vaccinations

For Madeira and the Azores there is a compulsory proof of the yellow fever vaccination, provided that you have entered a yellow fever area beforehand.

Recommendations by the Robert Koch Institute for mainland Portugal are aimed at vaccinations that are also common in Germany: tetanus, diphtheria, whooping cough (pertussis), polio, mumps, measles, rubella, pneumococci and shingles. Hepatitis A and possibly hepatitis B are added as travel vaccinations. For long-term stays by students and pupils, the recommendations are meningococcal C.

Protection against dengue fever in Madeira

In Madeira, diurnal mosquitoes can be responsible for transmitting dengue fever viruses. You can prevent this with a mosquito net and window gauze, anti-mosquito sprays and long, light-colored clothing, especially in children or chronic illnesses.

Healthy Mediterranean cuisine in the heat - can I eat and drink anything?

The tap water and spring water in Portugal are drinking water. On hot days, it makes sense to be careful with heated food, whether it is hot enough and cooked long enough - especially with meat, especially poultry, fish and seafood. Ice cream and dishes with fresh eggs, such as mayonnaise, should be fresh and cold. If you go where a lot of people are already eating, it shows that there is a large circulation of ingredients that are not stored for long. You can find fresh fish at one of the numerous fish markets, for example in the Algarve: in Quarteira (Loulé / Faro) and Olhão.

Swimming in the Atlantic

On the Atlantic coast, always expect undercurrents on the shore. They can pull you into the sea. That is why it is safest to swim on flagged beaches, within sight of lifeguards or another person.

Conclusion: For a vacation in Portugal, you are still insured through your German health insurance company. It makes sense to take out additional travel health insurance. It costs almost nothing for up to six weeks of vacation and you can go to a doctor or dentist privately in an emergency. It also insures your return transport to Germany.

The exciting thing about Portugal is: You will encounter a humane health system that gives all Portuguese people, even those with the lowest incomes, access to a doctor. We wish you a relaxing holiday in Portugal.

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