Doctors Press the Government to Undo Surgery Rules That Have Hospitals Halting Extra Operations
New SNS rules exclude lower-complexity procedures from the 'additional surgeries' programme that clears waiting lists, prompting some hospitals to suspend the extra activity. The Ordem dos Médicos, led by Carlos Cortes, is demanding an immediate reversal, warning of longer queues.
A change to the rules governing how Portugal's public hospitals run extra surgery has thrown the country's waiting-list programme into confusion, with some hospitals suspending operations and doctors demanding an immediate reversal.
At issue is the system of cirurgias adicionais — "additional surgeries" performed outside normal working hours and paid on top of a hospital's baseline activity, the main tool the SNS (Serviço Nacional de Saúde, the National Health Service) uses to clear its backlog. Under new criteria issued by the Direção Executiva do SNS (SNS Executive Direction), lower-complexity procedures are being excluded from counting toward the waiting lists managed under SIGIC (Sistema Integrado de Gestão de Inscritos para Cirurgia, the Integrated System for the Management of Enrolled Patients).
Hospitals pull back
The practical effect has been immediate: faced with rules that no longer recognise or reimburse a swathe of routine operations as "additional", several hospitals have halted that extra activity rather than absorb the cost. The stoppage lands squarely on the kind of high-volume, lower-acuity cases — cataracts, hernias, minor orthopaedic and general surgery — that make up a large share of the queue and are usually the quickest to clear.
The tightening sits alongside a broader instruction from the SNS Executive Direction to hold back growth in hospital consultations and surgeries in 2026 and to cap the human and financial resources devoted to them — a cost-containment drive that the medical profession argues is being applied to a service already stretched thin.
Doctors demand a rethink
The Ordem dos Médicos (Medical Association) has called for the measure to be changed at once. Its president, or bastonário, Carlos Cortes, warned that curbing activity in an over-pressured system would lengthen waiting lists, delay diagnosis and treatment, and add to patient suffering. "Freezing care activity in a system that is already under pressure is not a reform," he said, urging the government to pursue efficiency through better clinical governance, adequate investment and the recruitment of doctors rather than through blanket limits.
The association's argument is that excluding simpler operations does not make them disappear — it merely pushes patients further down a queue that the additional-surgery programme exists to shorten, while leaving surgical teams idle in the hours the scheme was designed to fill.
A system already mid-overhaul
The dispute comes as the health ministry is in the middle of replacing SIGIC altogether. A new waiting-list management platform is due to take over from the start of August, with the SNS promising greater transparency — letting patients track their own place in the queue — and rules meant to stop surgical teams cherry-picking which cases to take on. For now, though, the transition has produced the opposite of the intended reassurance, and the government faces pressure to clarify the criteria before the backlog it is trying to manage grows longer through the summer.
