EY-Parthenon Report Lands the Private-Health-Coverage Saving for the SNS at €1.945 Billion in 2023 — 9 Million Procedures Channelled, Surgeries Carry €846 Million and APHP-APS Press for Inter-System Fiscal Parity

The Associação Portuguesa de Hospitalização Privada (APHP) and the Associação Portuguesa de Seguradores (APS) released on Sunday 17 May 2026 the consultancy EY-Parthenon's report 'As Segundas Coberturas de Saúde em Portugal e o seu Impacto no Sistema Nacional de Saúde', a 2023-base reading of the volume of healthcare activity that private health-insurance, ADSE and other second-coverage subsystems channelled out of the Serviço Nacional de Saúde and the implied SNS-side saving. The headline number sits at €1.945 billion in avoided SNS spend in 2023, on the back of more than 9 million procedures diverted from the public system. Against the €14.5 billion SNS expenditure print for 2023, the calculated saving lands at roughly 13.4% of the public-system budget envelope for the year.

Where the €1.945 Billion Sits

The breakdown by line of activity gives the clearest read on which slices of the SNS service envelope the private second-coverage system carried in 2023. Surgeries are the heavyweight at €846 million of saved SNS spend, consultations carry €688 million, MCDT (meios complementares de diagnóstico e terapêutica — imaging, lab tests, electrophysiology and the long tail of diagnostic-and-therapeutic procedures) land at €234 million, emergency services at €143 million, deliveries at €13 million and the residual other-medical bucket at €21 million. The reading mirrors the cost-recovery weighting the SNS itself applies on the SINACC tariff schedule for convencionados hospitals, which means the saving is calculated at the marginal SNS-side cost of each procedure, not the higher headline cost a private-payer system would bear if it had to absorb the same volume without the second-coverage market structure.

The Inter-System Stakeholder Pitch

The APHP-APS-EY-Parthenon framing on Sunday rests on two stakeholder quotes that carry the policy ask underneath the headline number. José Galamba de Oliveira, president of APS, told the launch that private-health-coverage demand growth reflects citizens seeking 'previsibilidade no acesso' and 'maior controlo sobre o percurso clínico' — read as a soft critique of the SNS waiting-list-and-pathway architecture, particularly visible in the recent RNCCI 134-day Algarve waiting-list reading. Hermano Rodrigues, partner at EY-Parthenon Portugal, pressed the operational angle: 'tornar a experiência do segurado muito mais simples' through clearer pricing tables and accessible second-coverage information. The report's policy-recommendation page lists interoperable digital platforms between SNS and private operators on the patient-record axis, common clinical protocols so a privately-channelled procedure carries forward into SNS follow-up without re-investigation, support arrangements for vulnerable populations caught in the gap between full-out-of-pocket private payment and full-SNS-funded care, and — the highest-priority political ask — 'tratamento fiscal ajustado que elimine a discriminação público-privada', a direct push for parity between the IRS-deductible profile of out-of-pocket private health spend (currently capped at €1,000 per agregado familiar at the 15% deduction rate under Article 78-D of the IRS Code) and the full SNS-funding profile of public healthcare consumption.

How This Reads Against the Week's SNS File

The €1.945 billion saving lands in the same week as a dense SNS-services agenda: the SINACC tariff revision that the Health Minister pledged for convencionados hospitals, the tarefeiro-departure incompatibility clarification for SNS specialists, and the STEPH 21 May vigil at the Ministry of Health over the INEM Lei Orgânica. Each of those files reads the SNS strain from inside the public system; the EY-Parthenon report reads the same strain from the second-coverage market that has grown to absorb the consequent demand overflow. Both APHP and APS will press the Ministry of Health and the Ministry of Finance to anchor the report inside the OE2027 framing-document discussions, due to open in the Conselho de Ministros in July, with a particular focus on the IRS-deduction-cap rebalancing.

What This Means for Expats

The 2023 second-coverage population: roughly one in three Portuguese residents (around 3.3 million people) was covered by a private health-insurance contract, ADSE, SAMS or one of the smaller mutualist subsystems in 2023, with the share rising fastest among foreign residents — a function of the standard expat-package profile written by employer benefit programmes and of the take-up patterns the long-term-residence cohort displays once household income has stabilised. Expats sitting on the SNS-only side of the line carry the implicit cross-subsidy this report quantifies.
The IRS deduction window: the €1,000 deductible cap on out-of-pocket private health spend, applied at the 15% rate, has not been revised since 2017 and has lost roughly 20% of its real-terms value to cumulative inflation over the OE2018-OE2026 window. APHP and APS are pressing for both the cap and the rate to be revised; the OE2027 process is where any change would land.
The Médis-Multicare-Advancecare-Future-Healthcare four-operator structure: the four-named private-health-insurance operators between them carry roughly 80% of the Portuguese second-coverage book. Foreign-resident pricing varies materially on the questionnaire médico answers, on the age band and on whether the policy is anchored to a Médis, Multicare, Advancecare or Future-Healthcare hospital network; the EY-Parthenon report does not break out the operator-level competitive dynamics but the underlying market-share readings are in the ASF (Autoridade de Supervisão de Seguros e Fundos de Pensões) quarterly statistical bulletin.
The CRUE / NHS / S1 stack for EU expats: EU expats who arrive carrying an S1 portable-document from their home-country social-security system retain the full SNS-equivalent benefit profile without paying into the private-insurance side. The CRUE registration guide walks through the joining-up of the residency certificate, the S1 lodging at the Centro Distrital de Segurança Social, and the SNS Número de Utente assignment that follows.
The provider-network choice mechanic: for foreign residents who do take out a Portuguese private-health-insurance contract, the standard market choice is between Médis (the BCP-Ageas-owned platform anchored to the CUF, Lusíadas and Hospital da Luz networks), Multicare (Fidelidade's platform anchored to the Luz Saúde network), Advancecare (a network-rental operator), and Future-Healthcare (an open-network broker). Each writes a different waiting-period structure for pre-existing conditions and a different reimbursement schedule for out-of-network use, which is the operational consequence of the report's 'clearer pricing' ask.