Health Minister Disputes the SNS's 2,679 Million Euro Shortfall for 2027 and Promises Another Wave of Hospital PPPs

The national health service (SNS) is forecast to end 2027 with a negative balance of 2,679.4 million euros, roughly double this year's estimated shortfall, according to the Health Ministry's explanatory note on the 2027 State Budget. At a parliamentary hearing on Friday, 30 October, Health Minister Ana Paula Martins denied the SNS is under-budgeted, said the Government will launch "another wave" of public-private partnerships (PPPs) in health, and accused past governments of letting private hospitals open "wherever they wanted".

What the 2,679 million covers

The figure is the projected "saldo global" (overall balance) of the consolidated SNS account for the calendar year 2027. That account covers the local health units (ULS) that now run hospitals and health centres together, the IPO cancer institutes, INEM and the addictions institute ICAD. Table 7 of the ministry's explanatory note puts 2027 spending at 19,403.6 million euros against income of 16,724.2 million. The same table estimates a shortfall of 1,302.5 million for 2026 and a provisional 1,035.1 million for 2025.

The minister argued the comparison is misleading. As reported by Lusa via RTP, she said the figure is "the overall balance of an account of estimated needs, with no spending ceiling", including investment, and not a loss. The 2026 figure already includes an extraordinary top-up of 959.7 million euros granted in September; without it, she said, 2026 would close at minus 2,262.2 million, so the gap to 2027 is 417.2 million (18.4 percent), "not more than double". She stressed that the health budget itself, measured in cash, shows a surplus of 661.7 million euros.

Another wave of PPPs

"We never hid that we want to launch another wave of PPPs," the minister said, according to RTP. She said tenders can take five to seven years, that the State reform will speed them up, and that the partnerships will be "limited in number" and placed in ULS where the State and partners are most willing. She did not name any. In March 2025 the Government had announced PPPs for the ULS of Braga, Loures, Vila Franca de Xira, Amadora-Sintra and Almada (Garcia de Orta), but Observador reported in May that the study needed to justify them was overdue. This is separate from the building-only partnership being studied for Barcelos-Esposende.

"They opened where they wanted"

On private healthcare, she told MPs there had been no regulation in recent years and that private groups had opened clinics and hospitals "across the street from SNS hospitals". She said private providers should be partners, under transparent rules and prices.

She also said a new multi-year framework for SNS units, the Quadro Global de Referência 2027 to 2029, will be signed in the coming days. The Secretary of State for Health rejected claims of cuts to prevention, citing a 23.6 percent rise in the Directorate-General of Health's budget excluding Covid-19 vaccines, Observador reported. INEM's insurance-fee income is set to rise by 117.5 million euros, as we reported last week.

What it means for you

• Nothing changes at your health centre or hospital yet: the budget's final vote is on 24 November.
• The minister admitted the SNS has needed top-ups during the year for its local units and cancer institutes; this year's came to 959.7 million euros. Expect the same debate in 2027.
• Under a clinical-management PPP, a private group runs a public unit under a State contract; the plans announced in 2025 would cover health centres as well as hospitals. No unit has been named for the new wave.