Patients complain of spending more than necessary.

The questions were posed to the Ministry of Health, which referred them to the various organizations that operate within it. "1. Is there any study indicating the impact of the nearly one and a half million immigrants on the National Health Service (SNS) that has emerged in recent years? Or is it only 900,000? And what about immigrants who come to Portugal only to 'get better' and leave without paying? Are there figures on this situation?" The response from the Executive Directorate (DE) of the SNS was a jumble of words that say nothing: "Any foreign national with legal residence in the country can obtain an SNS user number, which entitles them to medical assistance in public units. The simple fact of having a user number does not imply coverage of expenses; it is necessary to have associated data such as identification, tax identification number (NIF), address, and a valid residence permit." Foreign citizens temporarily in Portugal (for study, work or tourism purposes) who hold the European Health Insurance Card (EHIC) or the Provisional Replacement Certificate are entitled to healthcare in the National Health Service (SNS), with costs subsequently reimbursed by their country of origin . Regarding the numbers and impact, zero.

"2. It is a fact that this year there are 250,000 more people with a family doctor. What is the reason for the number of patients without a family doctor not decreasing? " Here the answer was more assertive: "Regarding the assignment of family doctors, it is important to clarify that, as of September 2025, the number of users without a family doctor decreased by 75,772 compared to the same period of the previous year. In the same period, family doctors were assigned to 309,538 more users than in 2024, but there was also an increase of 233,766 new registrations in the National Health Service (SNS)."

The third issue concerned allegations that, under the Integrated System for Managing Surgical Waiting Lists (SIGIC), doctors earned more than 50,000 euros for a simple surgery. The newspaper Nascer do SOL questioned the National Health Service Directorate (DE) about surgeries that were postponed after the scandal broke with the news report on TVI/CNN , but there was total silence, with the matter being referred to the General Inspectorate of Health Activities (IGAS).

But while the SNS's Directorate of Health was sparing in its explanations on the issues raised, the same cannot be said of the Health Regulatory Entity (ERS), which answered all questions, explaining that the complaints received by the ERS "are classified as broad indicators, depending on the facts claimed" . This means that the number of complaints "may or may not involve cases compatible with what is intended in the questions" .

Patients 'forced' to spend more money

Let's then address the questions, some with surprising answers: "Has the ERS received complaints from patients who felt they were 'forced' to spend more money than necessary in private hospitals, due to alleged incentives that some doctors are 'obliged' to receive?" Always with due caution, it states: "The ERS has become aware of the following number of complaints classified as 'Financial issues > Excessive/abusive billing' (an indicator that may or may not include the cases under analysis), relating to providers in the private sector: 'In 2021, 3,746 complaints; in 2022, 6,563; in 2023, 3,742; in 2024, 2,907; and in the current year, up to October 27, 3,305'." The issue of private doctors having incentives to 'force' patients to spend more than necessary is common knowledge, although the Medical Association claims to be unaware of the fact (see page 17). This is strange, to say the least, when there are more than 3,300 complaints in just ten months. The Independent Doctors' Union (SIM), however, says it is aware of complaints from fellow doctors. When questioned about whether doctors, especially those working on a freelance basis, are 'invited' to schedule unnecessary exams, avoidable surgeries, or other treatments, SIM says that the complaints from those who are aware are more related to scheduling appointments for other, completely unnecessary specialties. Nuno Rodrigues, general secretary of SIM, believes that doctors are only protected if they have employment contracts with private (and public) healthcare providers. "The model we defend is that there should be a medical career path for all healthcare professionals. So that there are precisely these kinds of incentives to order exams, etc." "Then it becomes much more regulated and the worker is much more protected with a company agreement. Without it, being a service provider, the hierarchical power relationship is completely different. If you don't do it, tomorrow you're gone. In the case of someone who has a contract, it's not quite like that." Roque da Cunha, also from SIM, reinforces that the issue concerns the Order of Physicians and the ERS, but the Order should "invest heavily in investigating the complaints." Roque das Cunha further emphasizes that "it is fundamental that the clinical guidelines, which were drawn up by the DGS and the Order of Physicians, which guarantee the fulfillment of the medical act, be updated."

Preventable deaths and amputations

And what does the Portuguese Association of Private Hospitals say? Zero, although the same does not apply to the announced cuts in healthcare, which greatly worries the private sector, according to a union representative interviewed by Nascer do SOL . Let's continue with the questions posed to the ERS (Health Regulatory Entity), which, I repeat, answered everything. "How many complaints have you received in the last two years regarding medical negligence, namely deaths and amputations? How many complaints have you received about surgeries scheduled incorrectly, that is: the patient suffered from a specific disease and the doctor scheduled surgery for another problem?" Here, once again, the Health Regulatory Entity makes the necessary reservation: "The ERS exercises, under the terms of its Statutes, regulatory, supervisory and promotional and defense functions regarding economic activities in the health sector of the private, public, cooperative and social sectors." It is therefore important to emphasize that healthcare professionals are not subject to regulation by the ERS (Health Regulatory Entity) with respect to their activity, as this activity is subject to regulation and discipline by their respective public professional associations.

Thus, medical negligence may or may not fall under the categories classified within the ERS's (Health Regulatory Entity) framework of competences, namely the indicators: Adequacy and relevance of healthcare/procedures; Technical quality of healthcare/procedures; The ERS has become aware of the following number of complaints with the aforementioned classifications (indicators that may or may not include the cases under analysis), relating to providers in the public, private and social sectors – the reproduction of the text in full serves to avoid misunderstandings. Thus, in 2021, the ERS received 11,013 complaints from the public sector; 4,457 from the private sector; and 239 from the social sector. Last year, there were 10,915 complaints from the public sector; 5,593 from the private sector and 268 from the social sector. This year, up to October 27th, there were 9,003 in the public sector, 4,526 in the private sector and 263 in the social sector . Here are the numbers, but anyone who bothers to check the ERS website might not want to ever set foot in a hospital again, whether public, private, or social.

Based on information from the ERS website, the questions were posed: "How many users complained about the waiting time for surgeries categorized as priority?" While in 2021 there were 723 and in 2022, 709, and we are talking about periods of COVID-19, so far this year, 978 users have filed complaints.

Last question: "How many complaints have you received from patients who refused blood transfusions and doctors refused to continue treatment/surgery?" "The ERS (Health Regulatory Entity) has become aware of the following number of complaints classified as 'Respect for ideological, religious, ethnic or sociocultural beliefs' (an indicator that may or may not include the cases under analysis): 41 in 2021 and 25 in the current year."

This is a brief snapshot of the health sector in a week when budget cuts to the Ministry were announced.