Comparing Healthcare in Portugal vs the US: 5 Key Differences

Without your health, you have nothing – and that is why having the best possible healthcare, especially as you get older, is absolutely vital. In the United States, the healthcare system is a convoluted patchwork of insurance companies, corporate and government agencies, and incredibly high prices for most people.

So, it may come as a surprise to many Americans that most European countries are far ahead in terms of access to healthcare and its affordability. Whether you were born in Portugal or you are an expat, you will have access to high-quality healthcare without the struggles and exorbitant deductibles found in the States.

This article explains the major differences between the healthcare in Portugal vs the US and answers key questions you’ll likely have if you’re considering a relocation.

Healthcare systems are a vital aspect of any country, directly affecting the well-being of its inhabitants. The United States and Portugal offer two distinctly different approaches to healthcare. In short, the American healthcare system consists of private entities that are funded through insurance policies, as well as government agencies (the VA, Medicaid, Medicare) that operate for the benefit of specific populations.

The U.S. operates a primarily privately funded healthcare model, complemented by federal programs such as Medicare and Medicaid, whereas Portugal offers universal healthcare coverage to its residents through the Serviço Nacional de Saúde (SNS). Although many people have been fighting for universal healthcare for all in the United States, it has not yet become a reality.

Healthcare in Portugal vs the US

When comparing healthcare in Portugal and the United States, one must consider the diverse metrics that contribute to the overall effectiveness and efficiency of healthcare services. These include the quality of care, patient satisfaction, accessibility, and the cost of services. For most individuals, the cost of services is the biggest issue in the United States. It is often so high that quality of care and patient satisfaction are simply afterthoughts.

Portugal’s healthcare system focuses on ensuring that all residents have access to the necessary services, funded by general taxation. In contrast, the U.S. healthcare system is characterized by a higher expenditure per capita, driven by a combination of out-of-pocket expenses, insurance premiums, and government funding.

Healthcare Systems Overview

To understand the distinct healthcare systems of Portugal and the United States, you should begin by focusing on their governance, organization, and funding models.

Governance and Organization

Portugal’s healthcare is primarily managed by the government through the Serviço Nacional de Saúde (SNS), characterized by universal coverage. All residents, including expats who have residency status, are entitled to health care provided by the SNS, which is funded through taxation. The country also supports a private healthcare sector, offering additional options for those seeking alternative services or shorter wait times.

So, if you are considering becoming a long-term, permanent resident of Portugal, one thing that you won’t have to worry about is high health insurance prices. You will have healthcare available to you immediately without buying a policy of any kind. However, there are supplemental, private insurance policies that some people use as “add-ons” to the existing high-quality healthcare that is available to all.

In the United States, healthcare governance is a mix of public and private entities, without universal coverage. The system includes Medicare for the elderly, Medicaid for the low-income groups, and private health insurance, predominantly employer-based, for the majority. Under the Affordable Care Act, there are provisions to reduce the uninsured rate, but no single national health insurance exists to cover all citizens.

If you have attempted to purchase health insurance privately in the United States, for example as a self-employed person, then you know that anything other than the most basic coverage is simply too much to pay. No standard of care is available to all citizens without additional payment.

Funding and Expenditure

 PortugalUnited States
Expenditure as % of GDPMuch lower than the US18.3% of GDP
Per Capita SpendLowerHighest in the world
Funding SourceGeneral taxationMixed: employer-based insurance, federal and state programs, private out-of-pocket payments

Even though the standard of care is theoretically very high in the United States, the truth is that everyone doesn’t have access to it. Healthcare costs are known to be one of the biggest causes of bankruptcy in the States. Also, although the standard of care is high and the percent of GDP spent on healthcare is high, the truth is that the cost is significantly lower in many other countries.

Portugal’s health system is considerably more cost-effective than the United States. The expenditure on healthcare as a percentage of GDP in Portugal is significantly lower. The per capita spending on health is also lower in Portugal, which points to a cost-controlled environment in comparison to the high-spending, per-person costs in the United States, a country with one of the highest healthcare costs globally.

In short, the free market system just doesn’t work for healthcare – at least not for the consumers of it. The funding for healthcare in Portugal comes from general taxation, providing a universal approach, while the United States has a mixed funding model heavily reliant on private insurance and out-of-pocket payments, despite significant federal and state program support. So, many Americans have insufficient coverage or no coverage at all because they just can’t afford it.

Accessibility and Coverage

Accessibility and Coverage

In the United States, the truth is that not everyone has access to equal healthcare. If you are fully employed and your employer pays for your insurance, you are now in the minority. Most people are burdened with significant monthly payments for health insurance. Healthcare accessibility and coverage differ significantly between Portugal and the United States, reflecting disparate insurance models and population coverage.

Insurance Models

Portugal operates a universal public healthcare system, which ensures that all residents, including expatriates with residency status, have access to healthcare services. This system is predominantly funded by the government through taxes. So, from the first day you obtain residency, you can walk into an emergency room and get treated. They will not ask for insurance since everyone is eligible for treatment.

In contrast, the healthcare system in the United States is a hybrid of private insurance companies and government programs. Coverage is mainly obtained through private health insurance, either individually purchased or employer-provided, or through government programs such as Medicare and Medicaid for specific groups. Without insurance, many healthcare facilities simply won’t see you, and due to the patchwork of companies involved in the insurance process, a doctor who sees your next-door neighbor might not be eligible to see you.

Population Coverage

Portugal: The universal healthcare system provides coverage for the entire population. It means that every resident has access to essential health services without concern for individual insurance policies. This system of healthcare is what many people in the United States have been working toward, yet insurance companies don’t want this to happen.

United States: Coverage varies greatly, with an intersection of private insurance policies and government welfare programs. Despite various efforts, not the entire population is covered by public or private insurance. The level of coverage is often dependent on employment, income, age, and disability status and can change suddenly, leaving people with no coverage or incredibly high debt.

Healthcare Services Provision

Healthcare Services Provision

Not all healthcare falls into one category of course. During your lifetime, you may find times when you need emergency care, elder care, or any other type of care. In Portugal and the U.S., healthcare services provision is distinct in terms of structure and accessibility. The following subsections will compare primary care, specialized care, and the dichotomy of inpatient versus outpatient services in each country.

Primary Care

In Portugal, primary care is widely accessible through the public Serviço Nacional de Saúde (SNS). It serves as the first point of contact for patients and includes services from general practitioners. The SNS emphasizes comprehensive primary care to ensure universal coverage, even for expatriates with residency status. This type of care is what you would get from your General Practitioner or Primary Care Provider in the United States.

In contrast, the U.S. has a mix of public and private providers for primary care. While services are available, they can be costlier, especially for uninsured individuals. Insurance plays a crucial role in determining the affordability and accessibility of primary care services. In many instances, due to the cost of insurance plans as well as the cost of deductibles, many people forego primary care visits altogether.

Specialized Care

Specialized care in Portugal is also provided by the SNS but can entail longer waiting times. Patients often turn to the private sector for expedited services. The specialized care is inclusive but may require supplemental private insurance for faster access.

When this comes into play, you might need a joint replacement, a significant but non-urgent surgery, or some other situation. It won’t happen often, but when it does, you’ll be glad you purchased private-sector insurance.

The U.S. healthcare system has a plethora of specialized care options, with cutting-edge technology and treatments. However, these services can be significantly expensive, often necessitating comprehensive insurance coverage or high out-of-pocket payments. Many people put off having surgeries until they turn 65 and are on Medicare, simply because they can’t afford them otherwise.

Inpatient vs Outpatient Services

Portugal offers inpatient and outpatient services through both public and private hospitals. Outpatient services are readily reachable and are generally included in the SNS provision. Inpatient services are likewise accessible, with costs covered for those eligible under the SNS. It is surprising the first time you walk into a clinic or an emergency room and don’t need to pay anything!

In the United States, the distinction between inpatient and outpatient services is largely informed by the method of funding and insurance coverage. Patients with robust insurance plans have wider access to both inpatient and outpatient services, though high costs can still be a barrier for many. Many American insurance policies push people toward outpatient options simply because they are so expensive. It is not uncommon for women who have just given birth or individuals who have had a joint replaced to leave the hospital within hours!

Quality of Care

Quality of care should be a major concern, but when you are looking at price it often becomes secondary. In comparing the healthcare systems of Portugal and the United States, the quality of care is a critical aspect, including medical outcomes and patient satisfaction as key indicators.

Medical Outcomes

The medical outcomes, or general effectiveness of a healthcare system, cannot always be determined by coverage, but it is often somewhat representative of it. In other words, regions where there is little or no coverage often see a shorter life expectancy than populations that have provided the majority of their people with adequate healthcare.

Portugal’s healthcare system features the Serviço Nacional de Saúde (SNS), which provides universal healthcare coverage to residents. The SNS is known for ensuring accessibility to health services and contributing to positive medical outcomes.

Conversely, medical outcomes in the United States might be influenced by factors such as insurance coverage and the ability to afford care, potentially leading to variability in healthcare results across different populations.

  • Life Expectancy: Portugal has a life expectancy at birth of approximately 82 years, compared to the United States with a life expectancy of around 79 years. The life expectancy of American men is less than 78 years and has dropped in the past few years, primarily due to COVID-19.
  • Disease Prevalence: Both countries have made progress in reducing years of life lost to diseases; however, the gap between the U.S. and comparable OECD countries, including Portugal, has widened over time.

Patient Satisfaction

If you ask most Americans how they feel about their doctor, they might tell you that they never see them for more than 5 minutes during any visit. This is not at all unusual. Patient satisfaction in the healthcare system is contingent upon multiple factors such as wait times, healthcare accessibility, and the quality of patient-physician interactions.

  • Portugal: The public system aims for comprehensive care, which can result in longer wait times but generally meets the population’s health needs. The availability of private healthcare provides an alternative for those seeking quicker access to services.
  • United States: There is a diverse range of patient satisfaction levels, heavily tied to the quality of healthcare plans and the extent of insurance coverage. Those with comprehensive insurance often express higher satisfaction due to access to a broad range of healthcare services and providers. In other words, the more your insurance costs you (or your employer), the happier you are.

Healthcare Costs

When comparing healthcare costs between Portugal and the United States, one must consider both out-of-pocket expenses and cost-effectiveness to understand the financial implications for individuals.

Out-of-Pocket Expenses

In Portugal, healthcare expenses for individuals, especially expatriates with residency status, are often substantially lower than in the United States. Americans can expect to pay just a fraction of their usual healthcare costs when in Portugal. For instance, private health insurance is far more affordable, with reported monthly family rates as low as €53. The public Serviço Nacional de Saúde (SNS) ensures universal coverage, minimizing direct costs even further for residents.

In the United States, out-of-pocket expenses are significant. First of all, there is the cost of the insurance policy, followed by the deductible which can easily reach up to $10,000 per year or more. When you also factor in visit fees, prescriptions, lab fees, and more, many people wonder why they even have insurance at all.


The quality of healthcare in Portugal is rated highly, yet the costs are considerably lower when compared to the United States. An efficient public healthcare system along with competitive private sector pricing contribute to an overall high health care index. Statistical comparisons place Portugal higher on the index than the United States, suggesting better cost-effectiveness for services rendered.

Many Americans find the claims that other countries could have equitable outcomes at such a reduced price to be very dubious, but the truth is that most individuals in Portugal are extremely happy with their healthcare.

Impact of Healthcare Policies

Healthcare policies in Portugal and the United States have distinct impacts on their respective healthcare systems, influencing public health initiatives and the regulatory environment in ways that affect the countries’ populations. In short, the goal of the Portuguese people is to ensure that everyone is given the same high-quality level of care without dealing with the burden of debt brought on by poor health or insufficient insurance.

Public Health Initiatives

In Portugal, the public health initiatives are underpinned by the Serviço Nacional de Saúde (SNS), providing universal healthcare coverage to residents. This system allows for widespread access to medical services, aiming to ensure that public health measures reach all segments of the population effectively. There are many proactive programs under the SNS that are designed to improve life expectancy and reduce disease prevalence through preventive care, vaccination programs, and health education.

During your lifetime, you may be covered by a wide variety of healthcare programs or policies in the United States. If you are in the military or are a veteran, you would have military healthcare and subsequently, you would receive benefits from the Veterans Administration. If you are employed by a large company, your insurance may be considered a valued benefit of your employment. If you are poor, you would have Medicaid, if you are permanently ill or over 65, then Medicare would cover you.

The United States emphasizes a mixed approach combining public health programs with a robust private sector. Public health initiatives often vary by state, and their efficiency can be influenced by factors such as funding levels and population demographics.

Initiatives like the Affordable Care Act have sought to expand coverage, yet approximately 8% of Americans remained uninsured for all or part of 2019. The U.S. focuses on programs such as Medicare and Medicaid to assist vulnerable groups but still relies heavily on private insurance to facilitate broader public health measures. At present, some people want to repeal the Affordable Care Act altogether, leaving an even larger portion of the population without access to healthcare.

Regulatory Environment

Portugal’s regulatory environment for healthcare is more centralized, with the government playing a significant role in both oversight and delivery of healthcare services. Regulations in Portugal are generally aimed at maintaining the quality of services provided through the SNS, with a focus on cost control and accessibility. Unlike the United States, these regulations are not generally guided by local or state entities.

The regulatory environment in the United States is complex, with healthcare legislation and oversight managed at both federal and state levels. The U.S. Food and Drug Administration (FDA) is a key regulatory body that ensures the safety and efficacy of drugs and medical devices.

In addition to the FDA, there are numerous other regulatory agencies and health departments that create a very fragmented regulatory landscape. This complexity can lead to variations in healthcare standards and access across different states. Currently, there are many states that refuse certain procedures to women while these same procedures remain perfectly legal in other states. This can be very confusing for all residents.

Challenges and Improvements

Healthcare systems in Portugal and the United States face distinct challenges and are undergoing continuous improvements to meet the needs of their populations. By addressing these challenges, they can help to improve the overall health of their residents while keeping costs affordable to all.

Current Challenges

Portugal: Despite having a comprehensive public healthcare system, Portugal faces the challenge of economic constraints that have affected investment and resulted in resource limitations, impacting service delivery.

  • Economic Constraints: The impact of previous economic crises left Portugal with debts, influencing the level of investment in healthcare infrastructure and technology. The country is still working its way out of this situation.
  • Resource Limitations: There is a pressing need to modernize facilities and increase the healthcare workforce to reduce wait times and improve access to care. Having a high-quality, trained workforce will help to solve this problem.

United States: The most significant challenge in the U.S. healthcare system is the cost. When you combine that with disparities in access to healthcare services and varying health outcomes across different population groups it should come as no surprise that so many Americans are dissatisfied and underserved by their healthcare program.

  • High Costs: Healthcare in the U.S. is among the most expensive in the world, with significant out-of-pocket costs for patients even with insurance coverage. Bankruptcy due to healthcare issues is common and many people without insurance find themselves in poorer health due to neglecting doctor visits.
  • Access Disparities: There is a notable variation in healthcare access and quality, often linked to factors such as socioeconomic status, geographic location, and race. Some people, even those with insurance, may go years without ever seeing a doctor of any kind simply due to the lack of facilities and staff.

Future Directions

Portugal: The country is focused on reforming the healthcare sector to increase efficiency, quality, and accessibility, despite the financial challenges. This goal is designed to promote the overall health of the population, leading to a happier, more economically sound country.

  • Integrating Levels of Care: Aiming to enhance patient outcomes by better integrating primary, secondary, and tertiary care.
  • Investment in Preventive Care: Emphasizing the importance of preventive care to reduce the long-term burden on the healthcare system.

United States: The U.S. continues to seek ways to reduce costs and improve the equity and efficacy of its healthcare system. However, insurance and pharmaceutical companies (“Big Pharma”) are often on the other side of this quest, not wanting to reduce their profitability.

  • Healthcare Policy Reforms: Debate continues on how best to achieve a more cost-effective and equitable system, including discussions around public health insurance options. Pharmaceutical lobbyists are also engaged in maintaining the status quo.
  • Technology and Innovation: Embracing digital health and research advancements to improve healthcare quality and efficiency.

Comparative Analysis

It should come as no surprise that two countries – the United States and Portugal – would have such different healthcare systems. The healthcare systems in the United States and Portugal present distinct features, funding mechanisms, and outcomes.

Overall Comparison

One of the best ways to evaluate a country’s healthcare system is to compare what is known as the healthcare index. Portugal’s healthcare index, according to December 2023 figures, stands at 72.76, surpassing the United States index, which holds at 67.71. These indices weigh various aspects, such as access to healthcare, quality of services provided, and the general level of satisfaction with the system. The United States is renowned for its high per capita healthcare spending and advanced medical technology, yet it faces challenges such as unequal access and higher costs for individuals. You can see from the chart below that there are differences between these two healthcare systems in addition to the cost to consumers.

IndicatorPortugalUnited States
Healthcare Index72.7667.71
Healthcare SpendingLower % of GDP18.3% of GDP
System FocusSickness & WellnessSickness-focused
Private Healthcare FundingNot specifiedHigh

The U.S. healthcare system is predominantly funded by private sources and considerable personal expenditure, while Portugal’s system, part of the wider National Health Service, relies more significantly on public funding, with supplementary private options available. For most people, the Portuguese system is preferable not only because of its reduced personal and governmental costs but also because it is simply easier to navigate.

Cultural and Ethical Considerations

There are many reasons why the two healthcare systems are so divergent. Economic, political, social, and other factors all come into play. Cultural values and ethical standards shape the healthcare systems in the United States and Portugal. In Portugal, there is a strong emphasis on universal coverage and access as a fundamental right, which is reflected in the nation’s pursuit of comprehensive care for all citizens.

Conversely, the U.S. approach to healthcare often highlights the value of choice and diversity of services, which is a double-edged sword, providing options for those who can afford them but potentially leaving out segments of the population due to cost barriers.

Both countries face ethical dilemmas when balancing quality, access, and cost, but from different foundational philosophies regarding healthcare as a right or a market service. By understanding these cultural nuances, you will be better able to understand the effectiveness and patient satisfaction within each healthcare system.

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