Portugal
- Federica Andreoni
- Mohammad Al-Ubaydli
Country’s healthcare system in a nutshell
Portugal has universal health coverage through its public healthcare system called the Serviço Nacional de Saúde or SNS. The government fulfils both roles of payer and provider. As a provider, the SNS operates and manages healthcare facilities, including hospitals, health centres, and clinics, and employs a substantial portion of the healthcare workforce. Simultaneously, as a payer, the government finances the SNS through public funds, covering the costs of healthcare services and managing subsidies and co-payments to ensure access to care for all citizens and legal residents of Portugal. National health coverage includes all medical care apart from dental care costs. (Global Citizen Solutions, 2024).
As per Law Decree No. 37/2022, co-payments are only required for emergency services if the patient is not referred by the National Health Service (NHS) or if hospitalisation does not occur. Where co-payments are applicable, there are exemptions for those in financial hardship and within certain categories, that are not requested to pay. These are pregnant women, women in labour, children up to and including 12 years old, individuals with a disability of 60% or more, blood donors, living donors of cells, tissues, and organs, firefighters, transplant patients, and military or former military personnel permanently disabled due to service (SNS24, 2022).
According to the most recent data from 2010, health insurance covered the entire population of Portugal. This coverage encompasses both those who are members of health insurance schemes and those who have free access to state-provided healthcare services (Our World in Data, n.p.).
Public vs private
The pink column refers to the public expenditure as a % of the country’s total healthcare expenditure. The blue dot is the country’s expenditure on health per capita, expressed in international dollars at purchasing power parity.
The national PHR
History
Portugal created, throughout the years, various healthcare digital platforms with different purposes. The first patient-facing one, built in 2008/9, was an e-booking system, to allow people to book appointments with their GPs. The second portal, created in 2011, allowed patients to check their waiting time for surgery [PKB interviews].
It was not until 2011, when the country’s financial crisis required a bailout, that the first steps toward a more comprehensive patient portal were made, when the EU Commission gave Portugal 11 months to create a platform for data sharing, called Personal Computer Record. This was one of the requirements the country had to meet to get a 75 billion euro loan from the EU [PKB interviews].
Henrique Martins, at that time president of SPMS, - Portugal's Digital Health Agency - suggested 3 portals were to be created: a professional, a patient, and an institutional one.
The first to be launched was the patient portal, in April 2012, while the professional one was in July 2012. The latter connected 365 health centers. An app was created in 2017.
During the development and implementation of the platform, various challenges were encountered. First and most importantly, at the beginning of the project, there was a very low budget for it (€60,000), as it was hard to get political recognition of the economic utility of patient empowerment. The investment devoted to the portal up to 2023 accounts for €5-6 million. Another challenge was the shortage of programming skills among the population[PKB interviews].
Public portal (SNS 24)
Currently, SNS 24, by the Portuguese National Health Service, operates through four channels – SNS 24 Portal, Telephone Line, SNS 24 App and SNS 24 Counter – each dedicated to the objective of delivering information and services to citizens, thereby enhancing the accessibility of the National Health Service to the public (SNS24 website, 2024).
Within the platform, there’s an electronic health record portal (SNS 24 Portal) made up of two areas: the citizens and the professional area. In terms of the professional area, this is the system that supports the clinical procedures. All healthcare professionals who work in the national health service can access the EHR data between the different healthcare facilities in terms of primary care units and tertiary care units (SNS24 website, 2024).
Citizens can also login to their ‘personal area’ on the SNS24 Portal, where they can access the following information about their health, as collected at National Health Service (SNS) institutions:
their identification and contact details
the health centre where they are registered
the benefits granted to the patient (exemptions, contributions)
their allergies
the medication they are taking
diagnostics (diseases)
their position on the waiting list for surgery, if they are waiting for one
their vaccination record
their habits (how much they drink etc)
test results/measurements: BMI, Glycemia, Blood pressure, Triglycerides, O2 saturation, INR, Heart rate, Total cholesterol, LDL cholesterol, HDL cholesterol, HbA1c
Whether they are an organ donor
Through this service, they can choose who has access to this information (GP or doctors in a hospital, for example).
Patients can add their own data to most of the fields listed above, however, they have to choose from the options provided (i.e. they don’t have the ability to write their disease, rather, they have to select from a drop-down menu of diseases).
Initially, when the platform was created, data were coming only from public providers, including GPs. Over time, some private healthcare providers joined SNS 24, while others use other platforms.
Some patients' data are in the SNS24 portal regardless of the provider. These are prescriptions, sick leave, and certificates (such as the doctor’s certificate for the driving license).
In terms of data access, there are 2 different rules:
if the data was added by a professional, being this a private or public one, every other professional can see it.
if the data was added by the patient, the latter can decide whether he wants the professionals to be able to see it or not.
Public app SNS24
Through the SNS24 App, patients can access:
Vaccination Bulletin
Declaration of contact with the SNS 24 Line
Sick leave
Treatment Guides and dispensed medication leaflet
Health Agenda
Self-Declaration of Illness
ADSE Card
Blood donor card
living will
Multipurpose Disability Medical Certificate
QR Code – Electronic Kiosk
Pathologies (allergies and rare diseases)
Exams (Performance and Results Guide)
Clinical referrals
Consultation of usual medication
Application for renewal of usual medication
Contact your health facility
Contact with SNS 24 – via 808242424 and using the accessible contact – Portuguese Sign Language
Teleconsultation (via CSR Live)
Availability for teleconsultation: the user registers his/her availability to make teleconsultation
EU Digital COVID Certificate
Possibility to add multiple users
Access to the SNS 24 portal
Access to the App MySNS
Access to the App MySNS Times
Access to the App Telemonit SNS 24
Record 3 types of measurements: Glycaemia, Blood pressure, Body Mass Index
Challenges and areas for improvement
Some of the challenges encountered during the development of the system and its implementation:
An agreement/strategy with the private sector has never been developed, therefore, the data in the platform is limited to public healthcare providers' contributed data. This might be one of the reasons why usage has never been high (the growth in usage of the portal by patients was linear but never exponential) [PKB interviews].
Low digital literacy of patients (20% of Portuguese never used the Internet). For this reason, from 2015 there are administrative employees helping patients to use the portal [PKB interviews].
The main weaknesses and areas for improvement are the lack of data from private healthcare providers, and the platform's inability to integrate devices.
Patients can add their own data to their record, however, they have to choose from the options provided (i.e. they can’t write their disease, rather, they have to select from a drop-down menu of diseases).
Patients cannot share their records with trustees, but they can add emergency contacts.
Screenshots
Top left is ' my area',
Top right ' I need to…'
Bottom left ' my records'
Bottom right ‘know more’
Bibliography
AMA Administrative Modernization Agency. (n.d) Consult the personal area of the SNS 24 portal. Available at: https://eportugal.gov.pt/en-GB/servicos/consultar-o-meu-registo-de-saude-eletronico. (Accessed: 7 September 2023)
SNS24, 2022. End of user fees in the NHS [online] 1 June. Available at: https://www.sns.gov.pt/noticias/2022/06/01/fim-das-taxas-moderadoras-no-sns-2/ (Accessed 24 July 2024)
SNS24. (Last updated 14 March 2024). About Us. Available at https://www.sns24.gov.pt/how-can-sns24-help-me/. (Accessed: 1 May 2024)
SNS24. (Last updated 25 January 2024). SNS24 App. Available at https://www.sns24.gov.pt/how-can-sns24-help-me/. (Accessed: 1 May 2024)
Teixeira, J.G., de Pinho, N.F. and Patrício, L., 2019. Bringing service design to the development of health information systems: The case of the Portuguese national electronic health record. International journal of medical informatics, 132, p.103942. Accessed at: https://www.sciencedirect.com/science/article/abs/pii/S1386505618307767
Leontina Postelnicu (5 March 2020). How Portugal is advancing the use of eHealth in Europe. Available at: . (Accessed: 7 September 2023)
Global Citizen Solutions. (Last updated 29 April 2024). The Portugal Healthcare System: a Guide for Expats. Available at: . (Accessed: 1 May 2024)