A University of Glasgow Study Finds Portugal's Merged Local Health Units Missed Their Targets While Spending Climbed

The single biggest reorganisation of Portugal's public health service in a generation has failed to deliver on its own promises, according to an academic study that lands as the current government weighs whether to keep, unwind or overhaul the model it inherited. The research, carried out by the Portuguese economist João Pedro Martins at the University of Glasgow's Adam Smith Business School, concludes that the country's Unidades Locais de Saúde (Local Health Units) missed their business-plan targets almost across the board while their costs climbed.

The reform in question is sweeping. In January 2024 the previous Socialist government created 31 new Local Health Units, folding them in alongside the eight that already existed, so that 39 units now run virtually the entire Serviço Nacional de Saúde (National Health Service, or SNS). Each unit places a district's hospitals and its primary-care centres under a single Conselho de Administração (board of directors), with shared management and a common budget, on the theory that joining the two would smooth patient pathways and squeeze out duplication.

Martins's verdict is blunt. "The business plan targets were not achieved in large part," the study finds, "and causal analysis reveals increased spending without corresponding improvements in access, capacity or productive efficiency." In other words, the state is spending more on the merged units without the gains in waiting times, treatment volumes or value for money that the merger was sold on.

The academic finding echoes complaints already voiced from inside the system. The Associação Nacional das Unidades de Saúde Familiar (National Association of Family Health Units, or USF-AN), which represents family-doctor teams, has argued that the model was rolled out "à pressa" — in a rush — and that placing hospitals and primary care under one roof stripped local health centres of autonomy without giving managers the planning, resources or training to make the new structures work. In an earlier survey of unit coordinators, the association reported that the reform "had everything to fail, and failed."

The timing is awkward for the government, which is already fighting several fires in health. It has just told hospitals they will forfeit funding if they close their emergency rooms, and doctors are pressing it to undo new surgery rules that have hospitals halting extra operations. Brussels, meanwhile, has just flagged Portugal's chronic shortage of health professionals as a structural weakness to fix.

What This Means for Expats

• Your local unit is the SNS now: If you use the public system, the Local Health Unit for your district is the body that runs both your health centre and your nearest public hospital. Registering with a family doctor (médico de família) still runs through that unit.
• Don't expect quick fixes: The study suggests structural problems, not teething trouble. Access to appointments and elective surgery is unlikely to improve simply because the units exist, so factor realistic waiting times into any decision to rely solely on the SNS.
• Weigh private cover: Persistent capacity gaps are one reason many residents pair SNS registration with private insurance or a seguro de saúde for faster specialist access.
• Watch for restructuring: With the model now under academic and political fire, expect the government to tweak how units are governed or funded — changes that could alter which hospital or centre serves your area.

None of this settles the political question. The Local Health Units are less than two years old, and unwinding them would be its own upheaval. But with independent research now pointing the same way as the doctors and family-health teams working inside them, the pressure on the government to explain what it will change — rather than simply defend the status quo — is only going to grow.