I swear, I’m not lying…
Won recently had his annual physical. His out of pocket cost for the EKG (referred to here as an ECG) was 1,25€. Impossible you say? I would agree with you if we hadn’t experienced it ourselves, but it’s true. As this story unfolds, I will share all the costs for the office visit, blood work, chest x-ray and medications that were prescribed. Honestly? You won’t believe it. What is even more stunning is that I am using words like easy, fast, affordable, efficient, effective, and convenient to describe a healthcare system. Now there’s a first.
As a part of our transition to Portugal one of the first things we did was to switch from a US-based health insurance provider to a Portuguese-based provider. We were astounded at how much less expensive the premiums were vs the US for essentially the same level of coverage. At the time, our insurance broker instructed us to also sign up with the Serviço Nacional de Saúde (SNS), the Portuguese national health service. Eligibility is based on being a legal resident, so we had to wait until we had completed that step to move forward. The SNS provides free or vastly subsidized healthcare. You might be wondering why you would need or want both. Good question. Around 20% of the population opt for private health insurance to supplement their public health insurance. Private insurance covers extra services that the Portuguese healthcare system does not or to cover 100% of costs.
To register with SNS, our insurance broker recommended we hire a local woman who could help us since all the information and directions were in Portuguese. We paid her 30,00€ to fill out two forms (one for Won and one for me) and submit them on our behalf. She told us it could take up to four weeks since there was a single person responsible for processing all the applications in the entire Cascais municipality where we live. As it turned out we got our numbers in two days! We theorized that the shut down of the country due to the pandemic provided the over-worked employee a chance to catch up on their workload.
Healthcare in Portugal is funded through general taxation as well as from social security contributions paid by working residents. However, those who are not employed, dependent family members, and retirees do not have to make contributions. Portugal currently spends around 9.1% of its GDP on healthcare, making it the 12th biggest spender out of EU/EFTA countries. Around 70% is public expenditure and 30% is private.
Portuguese healthcare is ranked among the highest in the world, and has greatly improved over the past decade. The Euro Health Consumer Index ranked Portuguese healthcare as the 13th best in Europe in 2018, up from 20th place in 2015. Portuguese healthcare scored highest in terms of patient rights and information, accessibility and waiting times, as well as overall health outcomes. The life expectancy in Portugal is 81 years (in the US it is 78.5). The healthcare system has improved due to more public-private partnerships for new hospitals, changing hospital management structures, reforming pharmaceutical systems, reorganization of primary care and the creation of long-term care networks. Portugal has a history of dealing positively with immigrants in terms of healthcare, and many medical professionals are sensitive to language barriers. Virtually all doctors in the public and private systems speak English. Pharmacies are widely distributed throughout Portugal and many medicines, including over the counter medication, are subsidized if obtained with a prescription, which makes them very cost-effective.
Residents have to pay a small contribution towards certain costs for doctors, specialists, hospital treatment, and prescriptions, unless they are from a vulnerable or low-earning group.
We have been told that there is no distinguishable difference between the care you receive using the public health system or the private because most doctors work in both. The main difference is the wait time to see a specialist which will likely be shorter with private insurance.
Recently, Won’s been seeing a nutritionist. At his last appointment she suggested he get his blood work done to check his cholesterol and sugar levels (he’s prediabetic). He agreed since it was time for his annual physical anyway.
The first step was to select a doctor. To do that we reviewed a list of clinics and individual doctors near us that were in our insurance plan. The list was provided by our insurance broker. Won pulled up several clinics and looked at the ratings for each on line. He landed on one with a rating of 4.3 out of 5. Once he chose the clinic he went to their website where he was directed to select the type of doctor he needed from a long list that included areas of expertise such as Acupuncture, Cardiology, Dermatology, Infectious Diseases, Neurology, Orthopedics, Plastic Surgery, Podiatry, Speech and Language Therapy, Sports Medicine, Urology, Vertigo, just to name a few! He selected a general practitioner. Under that heading he then reviewed a list of doctors and their bios summarizing their education, experience, language capabilities and photo. He made a selection and was able to immediately view the doctor’s schedule and book an appointment directly on the website. Voilà! Doctor selection and appointment scheduling done. [For those reading this who are based in the US, because we have private health insurance, referrals to see specialists are not needed. We can book an appointment to see any doctor at any time. The doctor and the insurance company handle the paperwork on the back-end. I think I hear angels singing…]
I was originally going to accompany Won on his appointment (I find this to be more effective than hoping he remembers to tell me everything when he gets home), but I decided not to go at the last minute and it’s a good thing I did. Only patients were allowed inside the clinic due to pandemic-related restrictions. Everyone queued up outside. Each person was then greeted individually, had their temperature checked, escorted to a hand sanitation area, provided a queue number for the cashier and then directed to sit in a specific chair to maintain proper social distancing. Won waited no more than a few minutes before he was called up to the counter where he was asked to pay 12,50€ ($14.47). This was the cost for the office visit to see the doctor. He then returned to his seat and waited to be called in for his appointment. About five minutes later the doctor personally came out and called his name.
The doctor escorted him to her office/exam room where she entered everything directly into a computer. She provided Won with a computer-generated prescription for three different medications. The prescription listed the cost for each medication. I was amazed to see that a 3 month supply of his blood pressure medicine, the EXACT SAME medication he was prescribed in the US, was 1,34€. The doctor also gave him a prescription for blood work and a urinalysis. No appointment was necessary for those tests; he could come back anytime it was convenient. The EKG and chest x-ray did, however, require an appointment which he scheduled before he left the clinic for three days later.
He chose to go back the next morning to get the blood work and urinalysis done. He went through the same steps as the day before to enter the clinic and pay for the service. The blood test and urinalysis came to 12,63€ (there was no additional charge for an office visit). He knew in advance exactly how much it would cost because each line item on the prescription (all 24 aspects of the blood test) were listed along with their associated cost. They ranged from 0,08€ for the urinalysis to 2,10€ for a PSA (a prostate cancer screening test). He was in and out in about 20 minutes. If that wasn’t shocking enough, he received the results of all the tests later that same day!
He returned for his appointment to get the chest x-ray and EKG completed and followed the same steps to enter the clinic and pay. The total cost for these two tests was 2,85€ (again no office visit charge) and he received the results from his doctor four business days later. He was sent a message providing a date and time when he could pick up a copy of the EKG print out and a disc with his chest x-ray results, which he did.
In addition to all of the above, Won signed up to take a COVID-19 antibody test which was completely free. He received the results the same day and learned he has not been exposed. My test is scheduled for next week.
In total, all of this came to 27,98€ ($32.40). …take a moment if you need one. I understand.
Easy, fast, affordable, efficient, effective, and convenient. I’m officially impressed. Navigating a foreign healthcare system and having confidence and trust in the same was one of my biggest areas of concern before we moved here. After this, I’m beginning to seriously wonder what the US could offer that would temp me back.
Pretty pictures are back next week and they are of a place that you won’t believe is in Portugal!! Until then, stay safe, stay healthy, and stay in touch.
From Portugal with love,