Private Health Insurance Is Reshaping How Portugal Gets Medical Care, New Study Finds

A landmark study from the Nova School of Business and Economics has upended a common assumption about Portugal's healthcare system: the surge in private GP visits is not primarily driven by gaps in the national health service, but by the rapid growth of private health insurance.

The research, authored by Carolina Santos and Pedro Pita Barros in partnership with the BPI Foundation, found that having private health insurance increases the probability of consulting a private family doctor by 39 percentage points. By contrast, not having a doctor assigned through the SNS (Sistema Nacional de Saúde) raises the probability by just 6.3 points — roughly four times less.

The Numbers Behind the Shift

In 2025, 14.1 percent of Portuguese adults consulted a family doctor in the private sector. Of those, roughly 70 percent already had a GP assigned through the SNS. Just 4.2 percent of the total population went private because they lacked a public-sector doctor.

The pattern extends across coverage types. Private subsystem beneficiaries were 24.5 percentage points more likely to use a private GP. ADSE members (the public-sector health subsystem) showed a 15.2-point increase, while ADM beneficiaries (military and police) saw a 10.8-point bump.

According to the INE, about 79.5 percent of those aged 16 and over had at least one family medicine consultation in the previous 12 months in 2025. The national statistics body does not, however, distinguish between public and private consultations, making the Nova SBE data a crucial gap-filler.

A 1.7-Billion-Euro Market and Growing

Portugal's health insurance market is expanding at speed. The insurance regulator ASF reported that the sector billed 1.7 billion euros in gross premiums in 2024, up 18.9 percent from the previous year. The number of beneficiaries crossed four million for the first time (4,060,378 people), equivalent to nearly 38 percent of the 10.75 million users enrolled in the SNS as of January 2026.

Over the past decade, health insurance premiums have more than tripled, rising from 524 million euros in 2012. The ASF estimates that insurers now finance 5.3 percent of Portugal's total health expenditure.

Demand continues to outstrip supply. A recent Coverflex survey found that 73 percent of respondents consider health insurance an important part of their compensation package, but only 51.1 percent actually have it — suggesting significant room for market expansion.

What This Means for Expats

For the estimated hundreds of thousands of foreign residents in Portugal, this study has practical implications. While all legal residents can register with the SNS and receive a family doctor assignment, the reality is that waiting times can be long and availability varies widely by region.

The Algarve (19.3 percent) and Greater Lisbon (16.8 percent) lead in private GP usage, which aligns with the regions where most expats settle. But even in the northern coastal areas, where SNS coverage tops 94 percent, more than 10 percent of residents also use private GPs — a clear pattern of dual usage rather than replacement.

Most expat-oriented employers now include health insurance as standard in compensation packages, and NHR (now IFICI) visa holders typically arrange private coverage as part of their relocation. The study suggests this is a sound strategy: private insurance provides faster access and continuity of care, rather than serving as an emergency backstop for a failing public system.

The SNS Is Not Collapsing — It Is Being Supplemented

The researchers caution against reading this data as evidence of SNS failure. Losing access to a public GP only raises private usage from 13.4 to 18.7 percent — a moderate increase. The far larger driver is having the financial means, through insurance, to choose the private sector proactively.

As the study notes: "It should not be expected that greater coverage of family doctors in the SNS will significantly reduce the work of family doctors in the private sector." The growth of insurance is creating a preference-driven habit, not a necessity-driven one.

For Portugal's healthcare landscape, this is a structural shift. The ongoing pressures on emergency room capacity, the recurring public-sector strikes, and the government's own plans for new hospital construction all take place against a backdrop where a growing share of the population is quietly opting out of public primary care — not because it has failed them, but because they can afford an alternative.

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