Despite some innovations and innovations, as well as support from the state, Portuguese people continue to complain about health care and many, especially immigrants, remain silent because they are embarrassed and do not know the real consequences of complaints or are afraid of the reactions of professionals. However, it has been found that practicing the tactic of asserting one's rights and demanding compliance with the responsibilities of the health care system generally expands the relationship with the doctor, reduces medical errors and improves the quality of health care services.
First, I would like to talk about what is happening in practice in Portuguese healthcare? A recent sociological study indicated that almost half of the patients for whom a priority hospital appointment was requested waited more than 60 days, the maximum time limit set by law. "Has your family doctor referred you to see a specialist in the hospital in the past two years? How long did you wait?" These questions were part of a survey in April and May 2024. A total of 721 Portuguese between the ages of 30 and 79 answered the questions. About one in four answered "yes" to the first question.
About half of them were told by their family doctor that an appointment to see a doctor has normal priority. This means that by law it should take place within a maximum of 120 days, which, according to the respondents, was not the case in a quarter of cases. In the case of high-priority consultations (22%), the guaranteed maximum response time was exceeded in almost half of cases. The number of very high-priority consultations stated in the survey was residual. However, more than a fifth of respondents said they were not aware of the level of prioritization. The Health Regulation Authority unfortunately provides more alarming figures: in the second half of 2023, statutory limits were not met in 56% of cases, regardless of priority.
In the survey conducted, the vast majority of respondents who were referred to a hospital for consultation with a specialist (91%) admitted that they had never complained about waiting times: about a third did not complain because they had no reason to do so (legal deadlines were met), but there were also those who thought that it was not worth doing so because there would be no result (28%), and those who did not know that they could complain in principle (24%). Moreover, every fourth respondent did not know about the existence of guaranteed maximum response time, and only a minority of respondents said they were familiar with this information.
We have already written about the basic rights and obligations of health care users in Portugal, which are enshrined in the Constitution of the Portuguese Republic (Constituição da República Portuguesa), the Basic Health Law (Lei de Bases da Saúde) and other by-laws. Today we will not dwell on them in detail, but will go through them very briefly and highlight some important points for the current year 2024. We would like to remind readers that to have full access to all the rights described below, you must be registered in the Portuguese public health system SNS24, namely have a patient number número de utente or NUSS for short. So, what a patient can expect when applying to public health care facilities in Portugal:
- The person can choose services and professionals according to available resources and organizational rules, including choosing the health care facility where he or she would like to receive health care services.
The following information will be useful to you here: NHS agencies and contract holders are required to state the maximum response times in an accessible and easily visible place, publish them on their websites and on the SNS portal. Average response times for consultations by institution can be found online. The same is true for surgery. Regarding surgery, users can check their registration status, position on the waiting list and expected waiting time for surgery in the citizen's office on the SNS portal.
- May accept or refuse proposed tests and treatments.
Regarding this point, we would also like to open up a little: Patients have the right to receive all necessary information about an intervention or treatment from health professionals so that they can make their own decision and sign an informed consent. Informed consent (consentimento informado) refers to the informed authorization that the user gives before receiving any medical care, including but not limited to medical procedures, examinations, participation in research or clinical trials. Such consent involves an explanation and appropriate understanding of what is to be done, how it is to be done, for what reason and what is the expected outcome of the agreed intervention. In Portugal, written informed consent is mandatory for certain interventions, including:
- performing surgery and/or anesthesia, except for simple short-term interventions to treat superficial tissue lesions or readily accessible structures under local anesthesia;
- voluntary termination of pregnancy;
- prenatal diagnosis using invasive techniques such as amniocentesis;
- voluntary sterilization;
- placement of subcutaneous intrauterine contraceptives;
- medically assisted childbearing methods;
- living organ donation;
- administration of blood, its components and derivatives;
- collection, analytical examination, processing and cryopreservation of cord blood, tissues and placenta.
Consent must be obtained from all adults capable of giving it, or their representatives in the case of minors under the age of 16 or persons who lack the requisite discernment to appreciate its meaning and scope at the time it is given. Under the law, minors are capable of giving consent if they are at least 16 years old and have "the insight to appreciate the meaning and scope of the consent at the time it is given."
The law includes another interesting concept: implied or written authorization. The patient must consent to treatment, examination, surgery or clinical trials. Depending on the level of risk, this can be implied, verbal, or written permission. For example, by lying on a couch at the request of a specialist for observation, the patient is giving implied consent. In other situations, such as most surgeries, written authorization (the same informed consent) is required. The specialist must provide all necessary information about the proposed action in plain language and make sure it is understood. However, a document signed by the patient does not absolve the doctor from liability in case of error or negligence. You can withdraw your decision regarding an intervention or treatment even if you have signed an informed consent document. In private facilities, if you do not withdraw in a timely manner, you may have to pay, for example, a portion of the doctor's fee or room reservation. When you sign the document, the facility must specify the date from which you will have to pay these costs and their amount.
- Obtain access to appropriate treatment tools in a manner that is respectful of statutory time limits, technically correct, confidential and respectful.
I would like to note the following about time limits: The law provides guaranteed maximum response times for certain consultations, medical examinations, treatments and operations. If these are not met, you can and, in fact, must register a complaint in the complaints book. The law establishes maximum guaranteed response times (tempos máximos de resposta garantidos (TMRG) for non-urgent services in SNS health centers and hospitals. In the case of private providers contracted by SNS, the response time is fixed in the contract with the state and must also consider the TMRG. You can check on the ERS simulator whether the statutory time limit has expired and, if so, use the standard letters to file a complaint with (Entidade Reguladora da Saúde (ERS) and directly with the health center itself.
If your family doctor (or other primary care physician) has referred you for a consultation with a specialist, you can check the status of the request in the citizen's office on the SNS portal under "Consultas para mim > Status of request for consultation with a specialist" ("Consultas para mim > Estado pedido consulta especialidade"). According to the ERS, the health care provider has a maximum of five days (consecutive days, including holidays and weekends) to evaluate and book a consultation with a specialist, which is counted from the moment the request is received, and then must inform the patient of the place, date and time of the appointment, as well as the statutory deadlines for the provision of the health care he or she needs.
- Must receive health care with respect for the principles of equality, non-discrimination, confidentiality and privacy.
- He or she is given confidentiality of personal and health-related information.
- May require information about their clinical situation, treatment alternatives, and likely disease progression.
- Receive religious care, regardless of your faith (such as being hospitalized).
- Is entitled to post grievances and receive compensation for damages.
- Patients can form organizations, such as associations, to protect their rights.
- To have access to medical records, to be represented and accompanied.
The patient also bears some burdens of obligation, but these are fortunately many fewer than rights:
- It is the patient's responsibility to protect and promote health.
- Respect the rights of other patients, including the need for rest and quiet.
- Comply with regulations for the organization, operation and use of health care facilities and services.
- If necessary, pay for costs associated with medical care.
I would like to make a brief note here: as of June 1, 2022, you will only be charged for emergency care (serviço de urgência) without hospitalization. Example: you did not go to your health center to see your family doctor or the doctor on duty, but went straight to the emergency room of a hospital, as we all often do, with an urgent request. Even so, there is no charge if the patient went to the urgent care service following a referral from the National Health Service (SNS) or if they were admitted to hospital following the referral. An example of an SNS referral is an emergency referred by the primary care network (centro de saúde), a call center of the National Health Service (SNS24 line - 808 24 24 24 24).
There are categories of patients who, regardless of the circumstances, are always exempt from payment:
- Pregnant women and women in labor (even in cases of legally permitted voluntary termination of pregnancy).
- Minors (which you periodically have to remind the employees behind the counter when they write a check).
- Patients with a degree of disability (Utentes com grau de incapacidade) equal to or greater than 60% (they must have a certificate of multiple disability (atestado de incapacidade multiúso) when they go to the health facility.
- People in situations of economic insufficiency (insuficiência económica) and dependents in their family, which must also be documented).
I would like to remind you what this status is and how to obtain and confirm it: economic insufficiency is confirmed annually, based on the family income received in the previous calendar year.
Declaring economic insufficiency and obtaining this status can and should be done online:
- log in to your personal account on the SNS 24 portal;
- under "Learn more (Saiba mais)" in the main menu, enter "Moderation of charges for me (Taxas moderadoras para mim)";
- select the "Request (Pedido)" tab;
- click on the "Request an exemption (Pedir isenção)" button;
- fill in the fields labeled identification, family composition, etc;
- select "Confirm request (Confirmar o pedido)".
You can also resolve this issue by scheduling a video call with the ePortugal Contact Center. The videoconference will not only allow you to request a fee waiver on the grounds of economic insufficiency, but also to clarify any doubts you may have.
The most torturous and longest option is to go in person to the polyclinic in your place of residence and to the Loja de Cidadão Multifunctional Center.
In fact, you only need to apply once, as the situation is automatically reviewed on September 30 of each year by the Tax and Customs Authority (Autoridade Tributária e Aduaneira). Users with a valid registration at the employment center (centro de emprego) who receive unemployment benefits of 1.5 times IAS (€763.89 in 2024) or less, but cannot prove economic insufficiency because they are in a transitional situation or less than a year, can benefit from an exemption that also applies to their spouses and dependents.
To do so, they must present a declaration issued by the Instituto de Emprego e Formação Profissional, IP (IEFP), where they are registered, to the polyclinic to prove that they are unemployed. The declaration is valid for 90 days from the date of issue and can be renewed. If the user's situation changes, the relevant health center must be notified immediately.
Also exempted are:
- Blood donors (Dadores de sangue).
- Donors of living cells, tissues and organs (Dadores vivos de células, tecidos e órgãos).
- Firefighters (Bombeiros).
- Transplant patients (Doentes transplantados).
- Servicemen and ex-servicemen of the Armed Forces (Militares e ex-militares das Forças Armadas)
- Unemployed (Desempregados) with valid registration at the employment center, receiving unemployment benefit (subsídio de desemprego) equal to 1.5 times the Social Support Index (IAS) - €763.89 in 2024 - and their spouses and dependents (a certificate from the employment center (comprovativo do centro de emprego) must be provided.
- Young people in a support and protection process supervised by the Commission for the Protection of Children and Youth (Comissão de Proteção de Crianças e Jovens (CPCJ) or the court, who cannot prove economic insufficiency (they must submit an original statement issued by the CPCJ or the Family and Minors Court (tribunal de família e menores).
- Young people that are subject to guardianship in the form of internment, foster care, or guardianship in a public or private institution who cannot prove economic insufficiency.
- Young people who have been placed in foster care under a court order issued in a civil foster care proceeding and who cannot prove economic insufficiency (they must submit the original statement issued by the civil court that issued the order).
- Asylum seekers and refugees (Requerentes de asilo e refugiados) and their spouses or equivalent people and direct descendants (must submit a declaration confirming that they have applied for asylum or temporary residence permit).
It is also the patient's responsibility to:
- Keep your personal health care-related information up to date.
- Attend scheduled medical appointments in a timely manner.
- Collaborate with your doctors about your health: provide requested information and participate in decisions about your care.
Well, now about the topic from the field of medicine for today. The seasonal influenza and Covid-19 vaccination campaign for the fall-winter period of 2024 started on September 20, 2024. The vaccines will again be available at pharmacies and SNS health centers. According to the regulation that came into effect on September 5, vaccination started even earlier this year so that the maximum number of eligible people would be vaccinated by the end of November. This is to increase protection during the months of greatest risk and highest circulation of respiratory viruses. This year, people aged 85 and over, as well as those living in residential care homes for the elderly and equivalent and in the national integrated long-term care network (RNCCI), will be vaccinated against influenza with a high-dose vaccine (a vaccine with a higher concentration of antigens than the regular vaccine). The intensification of the seasonal influenza and Covid-19 vaccination campaign is part of the Health Emergency and Transformation Plan (Plano de Emergência e Transformação da Saúde) presented by the government in May 2024. The published decree emphasizes the importance of influenza and Covid-19 vaccination to prevent disease transmission, reduce morbidity and mortality among at-risk groups and help the health system overcome winter difficulties, reduce the demand for health care and the likelihood of hospitalization.
Although the World Health Organization (WHO) no longer considers Covid-19 a public health emergency, the European Commission continues to ensure simultaneous access to the vaccine in all Member States. In addition, the European Center for Disease Prevention and Control (Centro Europeu de Prevenção e Controlo de Doenças (ECDC) maintains the indication for seasonal vaccination against Covid-19 using vaccines adapted to circulating strains of SARS-CoV-2 virus. As last year, both vaccines can again be administered at pharmacies as well as at National Health Service (SNS) health centers.
Influenza and Covid-19 vaccination is recommended and free for the following eligible populations:
- people aged 60 years and over (including older people aged 85 years and over);
- attendants and residents of senior living centers and similar structures;
- people with risk pathologies;
- pregnant women;
- health care providers (public and private) and other health care providers;
- students;
- firefighters involved in patient transportation;
- caregivers of dependent individuals;
- drug distribution specialists;
- homeless people and prison inmates.
Anyone in the eligible group can contact the SNS medical unit that organizes vaccinations or get vaccinated at community pharmacies. You can schedule an appointment directly at the pharmacy, by phone or on the appointment platform.
As part of the 2024/2025 vaccination campaign, it is recommended that the influenza vaccine and Covid-19 vaccine be administered concurrently whenever possible. This practice is considered safe and effective. Influenza vaccine and Covid-19 vaccine can be administered on the same day if they are immunized at different anatomical sites (e.g., one in the right arm and one in the left arm).
To protect yourself from the flu, you should get vaccinated every year because the virus changes easily from year to year. A previous vaccination does not guarantee protection, especially if you are attacked by a new strain of the virus. Likewise, if you had the flu last year, you are not immune to the new flu. This is why the composition of the flu vaccine is revised every year. The World Health Organization oversees a global surveillance network that tracks flu activity and observes the evolution of viruses. Based on the data it receives, it determines the composition of the vaccine each year.
For those categories of citizens who are not entitled to free vaccinations, inactivated quadrivalent influenza vaccines will be available for sale:
- Influvac Tetra;
- Fluarix Tetra;
- Vaxigrip Tetra;
- Efluelda, a high-dose vaccine.
For citizens not covered by free vaccination, influenza vaccine is available at municipal pharmacies with a prescription and subject to stock availability. The Influvac Tetra and Vaxigrip Tetra vaccines have the same price. They cost €8.88 for general scheme users (37% discount) or €6.77 for the special scheme for pensioners.
The Covid-19 vaccination strategy for this fall and winter recommends a seasonal booster dose to maximize protection of the most vulnerable populations and prevent severe illness, hospitalization and death from Covid-19. The group of people eligible to receive the seasonal booster dose of Covid-19 vaccine include:
- people age 60 and older;
- people aged 5 to 59 years with risk pathologies;
- people aged 6 months to 4 years with severe to moderate immunosuppressive conditions;
- pregnant women;
- specialists in residential care homes for the elderly and similar institutions;
- health care professionals (public and private) and other health care services, students in clinical training, firefighters involved in patient transportation, caregivers of addicted persons, and pharmaceutical distribution professionals.
Considering risk pathologies:
- 6 months to 17 years: active malignancies, transplantation, immunosuppression, HIV infection, neurologic disease, developmental disabilities, diabetes, obesity, cardiovascular disease, chronic renal failure, and chronic lung disease.
- From 18 years of age (inclusive): active malignancies, transplantation, immunosuppression, HIV infection, neurological disease, mental illness, chronic liver disease, diabetes, obesity, low weight, cardiovascular disease, chronic kidney disease, chronic lung disease and other diseases such as trisomy 21 and lysosomal diseases.
A seasonal booster dose of the mRNA vaccine (BioNTech/Pfizer) is recommended for the fall/winter Covid-19 vaccination campaign in 2024-2025. Eligible individuals should be vaccinated provided they have completed the primary vaccination calendar with any of the Covid-19 vaccines, regardless of the number of previous boosters or previous history of SARS-CoV-2 infection.
The recommended interval between the seasonal booster dose and the last event (last dose of COVID-19 vaccine or diagnosis of SARS-CoV-2 infection) is a minimum of six months for people aged 6 months to 11 years and four months to a maximum of six months for people aged 12 years and older.
It is important to emphasize that vaccination against Covid-19 is voluntary (anyone can offer to be vaccinated at a health center). It is understood that people aged 16 years and older who seek vaccination give their informed, free and informed consent. Vaccines may be administered to persons under 16 years of age, provided a parent or legal guardian of the minor is present. If adults are unable to give consent, authorization must be obtained from their legal representative.
I hope you will find this article useful and informative. Traditionally, I wish you good luck and good health, and if you get sick - iron nerves and patience. Be polite, but persistent, and everything will be fine! On the medical topic we have, by the way, written quite many articles, I recommend reading - there are a lot of different useful things. However, as well as on other topics on our portal you will find enough useful information.
