Portugal plans to charge irregular migrants for healthcare

Portugal plans to charge foreigners in an irregular situation for healthcare

Portugal's government has put forward an initiative to stop paying the healthcare bill of those who do not legally reside in the country. Prime Minister Luís Montezaino's PSD and its governing partner, the Christian Democrat CDS-PP, have introduced a reform of the Health Framework Law in the Assembleia da República that redefines who can benefit from the Serviço Nacional de Saúde (SNS), Portugal's public health service. The bill, registered on September 25, keeps public healthcare for foreigners with regular residence and makes it conditional for everyone else: those who cannot prove legal residence will have to pay for care or demonstrate that an insurance policy, an international agreement, or another entity is responsible for the cost. The measure is not unprecedented. A very similar initiative passed a first vote in the previous legislature with the support of Chega and was frozen when the election was called early. Now it is back, with changes and amid political pressure over immigration.

What happens if an undocumented foreigner goes to the emergency room?

The short answer is that they are treated. The reform includes an express exception for cases of medical emergency or risk to life: care will continue to be provided regardless of the patient's administrative status. What changes is what comes after. Once the emergency is over, the bill provides for demanding the documentation needed to determine who bears the cost and opens the door to measures such as financial guarantees or advance payments in certain cases. The sponsors' stated goal is twofold: to identify who is financially responsible for each episode of care and to make it easier to collect payment afterwards. Those who cannot prove it, pay.

The figures behind the reform: 330,000 emergency visits and 140,000 without coverage

The numerical argument comes from the Inspectorate General of Health Activities. Between 2021 and September 2024, around 330,000 non-resident foreigners went through Portuguese hospital emergency rooms. Of these, more than 140,000 had no insurance or international agreements covering the cost of their care. To this figure they add a qualitative diagnosis: they claim that Portugal is seeing an increase in non-EU citizens travelling to the country to be treated through the public system. This is the part the government does not quantify with the same precision, and the one that sparks the most debate.

Medical tourism and the pull effect at the border

Comparisons with other models come up in the debate. One participant argues that in Switzerland legal residence requires mandatory private health insurance and presents that model as the formula that prevents the public system from shouldering demand that is not its responsibility. Another points out that the United States also cannot refuse emergency care, but that non-payment is absorbed by insurers and ends up raising everyone's premiums. Among critics of the measure, there is a suspicion that the problem is not solved but displaced: if the irregular patient does not pay in Portugal, they will cross into Spain, and the first to notice would be the network of hospitals and health centres in the border provinces, Badajoz among them. No one has yet put a number to that hypothesis.

The counter-argument: the SNS's problem is doctors, not migrants

The Portuguese Communist Party rejected the proposal and accused the government of focusing on foreigners to avoid addressing the SNS's structural problems: a shortage of professionals and insufficient investment. This is the crux of the dispute. One side argues that charging non-residents brings order to the system and discourages abuse. The other replies that the bill will keep being paid by the taxpayer, because seizing assets from someone who is not in the country is an administrative fantasy, and because a system with understaffing is not fixed by changing the front door. Both things can be true at once.

With the reform still in the legislative process and no implementation date, some participants take for granted a partial shift of demand towards the neighbouring country and an increase in paperwork at reception desks. How much of each, and whether it relieves congestion at all, is something no one dares to vouch for yet.