Public-Private Hospital Relaunch Misses Its April Deadline — ACSS Comparator Study Slips Past the Government's Own Cut-Off, Even as the OE 2026 Lifts the PPP Budget by 40% to €325M for Braga, Loures and the Lisbon Arc

Six months after the government in October 2025 set itself an April 2026 cut-off, the Administração Central do Sistema de Saúde has still not delivered the study that the Ministry of Health is supposed to use as the technical justification for relaunching public-private partnerships at five hospitals — Braga, Loures, Vila Franca de Xira, Amadora-Sintra and Garcia de Orta. The Ministry confirmed to Público on 25 April that the study "is being conducted" by ACSS but is not yet ready, despite the original timetable promising delivery in the same month.

The political stakes are large. The PPP track is one of the cornerstones the XXV Government inherited from its predecessor and recommitted to in coalition negotiations; the State Budget for 2026 already lifts the dedicated PPP line by 40% to €325 million, on the basis that the relaunch would be in motion by the second half of the year. The €325 million figure includes an extra €13 million for Cascais Hospital — the only PPP that survived the previous decade's de-privatisation cycle — and provisions for the future Hospital de Lisboa Oriental in Marvila.

What the study is supposed to do

The legal framework for re-privatising hospital management requires the State to demonstrate that a PPP arrangement delivers value for money compared to direct public management. ACSS is the technical agency tasked with the comparator analysis: capital cost, operating cost, service quality, productivity and risk-transfer profile, all benchmarked against the in-house alternative. Without that document the Ministry cannot legally launch the concession tenders for the five hospitals named in October.

The five sites cover building management as well as primary-care delivery for the two Local Health Units — ULS Amadora-Sintra and Garcia de Orta — that combine hospital and primary-care functions. The Ministry has signalled that the building-management track will probably move first, with the clinical-services partnership following in a subsequent tranche, but neither timetable can begin while the comparator analysis remains unfinished.

Why the slippage matters

The Ministry of Health is also dealing with a quieter operational problem the Sindicato Nacional dos Médicos surfaced in February — hospitals across the SNS still have not received the 2026 contract-performance targets they need to plan capacity, hire fixed-term doctors and order equipment. The Termos de Referência that anchor the annual contract cycle have been delayed by months, and the PPP study slipping past April adds another item to the backlog of foundational documents that are not landing on time.

Minister Ana Paula Martins last week told the parliamentary health committee she would not resign — "não saio de fininho" — and admitted publicly that the SNS recorded fewer consultations and fewer surgeries in January and February 2026 than in the same months of 2025. The combination of slipping study deadlines, missing performance targets and a measurable decline in activity creates the political environment that opposition parties are using to question the operational competence of the ministry as it heads into the May parliamentary debate cycle.

Where the relaunch goes from here

The realistic timeline now points to a study landing in May or early June, draft tender documents in the summer recess, and the first formal procurement notice in September or October. That would push the actual concession start dates into 2027 — a slippage that compresses the window for the contracts to deliver any meaningful operational impact before the next legislative cycle ends. The Cascais PPP renewal, which is on a separate contractual track, remains the immediate test case for whether the model still works on the Portuguese health-system fundamentals.