Portugal’s national health service ends 2025 with €1 billion deficit

Portugal’s SNS national health service ended 2025 with more registered patients, a rising number of people without a family doctor and a budget deficit exceeding €1 billion, according to a new report.

The report paints a mixed picture of the SNS – showing improvements in some areas while confirming that primary care, emergency departments and the health service’s finances remain under significant pressure.

More patients, but family doctor shortage worsens

In line with the population growth, the SNS registered around 10.7 million users in 2025, reversing the slight decline recorded the previous year.

However, the number of people without a family doctor increased to 1.56 million – up by 41,000 from 2024. Around 70% of those patients were concentrated in the Lisbon and Tejo Valley region, underlining the continuing pressure on primary healthcare services in and around the capital.

The total number of medical consultations in primary care fell by 0.9% compared with 2024, ending the recovery seen the previous year.

The decline was driven by a 4% reduction in face-to-face appointments, while remote consultations continued to grow, rising by 3.3%.

Emergency departments still struggling

Hospital emergency departments recorded fewer patient episodes during 2025, but the report found that waiting times remained well above recommended standards.

Only 44% of patients were seen within the recommended maximum waiting times, highlighting persistent capacity problems despite a reduction in demand.

Emergency health plan only partially implemented

The government’s Emergency and Health Transformation Plan, approved in May 2024 and comprising 54 measures across five strategic areas, achieved only partial and uneven implementation (very much as critics suggested would happen).

A second progress report, covering developments up to March 31, 2025, acknowledges improvements in access to healthcare and clinical activity but concludes that pressure on the SNS remains high, particularly in primary healthcare and continuing care services.

Deficit tops €1 billion

The provisional consolidated accounts prepared by ACSS, the health system’s central administration, show the SNS recorded a deficit of €1.035 billion in 2025.

The shortfall was significantly higher than the €217 million deficit forecast in the State Budget but represents an improvement of €534 million when compared with 2024.

The report notes that the SNS continues to depend on extraordinary capital injections from the state to maintain financial stability.

Between 2016 and 2025, these additional government contributions totalled approximately €7.9 billion – although they are not reflected in the annual budget balance.

Revenue and spending both increased

Total SNS revenue reached €15.93 billion in 2025, an increase of 10.8%, or €1.55 billion, compared with the previous year. Tax revenue transferred through the State Budget remained the health service’s main source of funding, accounting for 93.9% of total income.

Total expenditure climbed to €16.96 billion, up 4.4% or just over €1 billion year-on-year.

The increase was largely driven by an additional €502 million in staff costs, €333 million in external goods and services, and €158 million in inventory purchases.

Supplier debt and payment delays increase

The SNS’s debt to external suppliers rose by €148 million during 2025, reaching €1.5 billion by year-end.

Average payment times also deteriorated, rising from 77 days in 2024 to 95 days in 2025. Only 11 of the SNS’s 47 public health entities met the government’s target of paying suppliers within 60 days.

The report concludes that while the SNS maintained high levels of activity throughout 2025, growing financial pressures, persistent staffing shortages in primary care and continuing difficulties in hospital emergency departments remain among the biggest challenges facing Portugal’s public health system.

Source material: Executive Digest