Health Minister Weighs a Weekly Charge for Patients Who Refuse a Continuing-Care Bed
Ana Paula Martins says she may consider a fee — backed by the national ethics council — for discharged patients who reject an available continuing-care place and stay in hospital. Care providers counter that the real problem is a shortage of beds.
Portugal's health minister has floated a charge that could land on patients who are cleared to leave hospital but refuse a place in the country's long-term care network, keeping a bed occupied that an acutely ill patient might need. Ana Paula Martins said she is willing to consider a weekly fee for people who turn down an available spot in the Rede Nacional de Cuidados Continuados Integrados (National Network of Integrated Continuing Care, or RNCCI) and choose to remain in an acute ward instead.
The idea is not the minister's own. It comes from an opinion issued in late May by the Conselho Nacional de Ética para as Ciências da Vida (National Council of Ethics for the Life Sciences, or CNECV), which proposed a "progressive weekly fee" — one that could rise to the full cost of a continuing-care stay — for patients who decline a placement without good reason. The council paired that with a safeguard: any bed offered should be no more than 90 minutes' travel from the patient's home, so that no one is pressured to accept a place far from family.
Martins raised the proposal in Torres Vedras, at the opening of what the ministry describes as the country's first "model C" family health unit, calling the ethics council's opinion "one more contribution" to a difficult debate. The problem it addresses is real and costly: at any given moment, nearly 3,500 hospital beds across Portugal are occupied by patients who no longer need acute care but have nowhere suitable to go — so-called inappropriately hospitalised patients who block admissions and lengthen waits behind them.
Not everyone accepts that a fee is the right lever. The Associação Nacional de Cuidados Continuados (National Association for Continuing Care, or ANCC) pushed back sharply, arguing that the real bottleneck is a chronic shortage of beds rather than patients unwilling to move. Its president, José Bourdain, noted that the RNCCI was originally designed to hold some 5,500 beds, roughly half of which never materialised. He singled out the Lisbon and Tagus Valley region — the most under-served in the country — where more than 2,000 planned beds have produced only about 100 in practice.
That gap frames the dilemma. If a suitable continuing-care place genuinely exists within reach, a patient who refuses it does hold up the system for others; but where the network is threadbare, a fee risks penalising people for a scarcity the state itself created. The CNECV's 90-minute rule is meant to address exactly that tension, tying any penalty to the existence of a real, nearby alternative.
For residents and their families, the practical takeaway is that no charge yet exists, and any move to introduce one would have to clear legal and political hurdles first. But the debate signals where the pressure is building. With acute wards straining and the continuing-care network still far short of its promised size, the government is searching for ways to keep hospital beds flowing — and is now willing to discuss asking patients themselves to share the cost of staying put.
