The health care system in Portugal is characterized by three coexisting systems: the National Health Service, special public and private insurance schemes for certain professions (health subsystems), and private health insurance. The Ministry of Health coordinates all health care provision and the financing of public health care delivery. Most of the population is entitled to choose between two health care insurers: the National Health Service and the health insurance. Approximately 20-25% of the population is covered by a health subsystem.

Health care providers can be either public or private, with different agreements with respect to their financing flows, ranging from historically based budgets to purely prospective payments. The main source of funding of the National Health Service is general taxation. Financial resources directed towards health care have reached a high level relative to the country’s wealth.

What happens if you need to see a doctor?
In Portugal, every Portuguese citizen and foreigners with legal residency who are working and contributing to the Social Security can (and must) obtain a User Number and be assigned a physician. This entitles the holder to discounted health treatment and basic national health coverage which includes all care except dentistry. To make an appointment to see a doctor, if you have insurance, you can choose a clinic and a doctor and go there. If you are covered only by the National Health Service you have two options. If you already have a doctor assigned to you, you can make the appointment by calling the hospital or health centre or going online through the Health Portal. If you don't have a doctor, you can try to make the appointment for the doctor in service that day. All users are charged with a moderation tax with few exceptions, such as Diabetes related consultations for people with diabetes.

If the doctor prescribes medication, you can go to any open pharmacy (identified by their green cross). There is no one set prescription charge in Portugal – prescription medicines are subsidised from 15% to 100%, depending on their use and need. In the event of an accident or emergency, the number to call is 112 and there is also an information hotline to phone to clarify any doubts about health – Linha Saúde 24 (808242424).

Who decides what doctors can prescribe?
Under the aegis of the Ministry of Health the National Institute of Pharmacy and Medicines (INFARMED, I.P.) is the National Regulatory Authority that evaluates, authorises, regulates and controls human medicines as well as health products namely medical devices, homeopathic products and cosmetics. The prescription of medication is made by International Nonproprietary Name (INN) in order to focus on prescription drug choice, allowing the rational use of medicines.

Practically, what is it like to live with type 1 diabetes in Portugal?
Most of the young people with type 1 diabetes believe that there are almost no differences between them and their friends without diabetes. People with diabetes have the ability to perform any kind of activity.

In Portugal, there is a maximum price for test strips, ketonuria and ketonemia and needles, syringes and lancets for people with diabetes. The Portuguese state covers 85% of the cost of test-strips and 100% of the price of insulin, needles, syringes and lancets. The technology of insulin pumps only reaches 1,150 of the nearly 50,000 people with type 1 diabetes (2.3%). This is because the state only funds 100 insulin pumps and consumables per year, so if anyone else wants to buy an insulin pump, they have to pay full price.

What about getting admitted to hospital?
In most hospitals there are different levels of urgency, on a scale of 4 levels of severity. When there is need to go to the hospital, the National Health Service gives an urgent admission for people with diabetes.

Before going to the hospital, and in the event of an accident or emergency, there is an information hotline to phone to clarify any doubts about health which sends the information directly to the hospital before the arrival of the patient.

How does diabetes care vary throughout Portugal?
In Portugal we do not see too many differences in health care for people with diabetes. The main differences relate to the quality of health professionals and referral hospitals, which are better in areas of high population density.

We would like to thank Jenifer Duarte, Alexandra Costa, and Manuel Gonçalves for providing this information.