The conversation you are likely to overhear in a Lisbon café these days is no longer about who can score football tickets but rather about how long it takes to see a cardiologist. Concerns over Portugal’s cherished public health service have moved from the policy pages to everyday life, and a new nationwide survey underlines why: most citizens sense that the Serviço Nacional de Saúde (SNS) is losing steam, even if they still praise the hands that hold the stethoscope.
A Quiet Shift in Public Mood
The latest inquiry by the Behavioral Insights Unit at Católica-Lisbon reveals a broad feeling that the quality of care is sliding. Among 1,134 adults questioned in mid-July, almost 90 % believe the SNS is deteriorating and 85 % fear being left unattended should serious illness strike. While Portugal’s public system was once cited across Europe as a model of universal coverage, the poll suggests a sudden erosion of confidence that cuts across region, age and income. Older respondents, traditionally the staunchest supporters, proved only marginally more optimistic than people in their 20s.
Numbers Behind the Discontent
Waiting times sit at the centre of the frustration. More than one-third confess they have postponed consultations or treatments because lines are too long. Official dashboards confirm the lived experience: 902,814 people were still waiting for a first specialist appointment at the end of 2024, and over 55 % had already exceeded the legal deadline. Surgical backlogs tell a similar story. Even after a record 789,508 operations were performed last year, roughly 75,000 patients remained beyond the guaranteed time limit. The telephone helpline SNS 24—once heralded as a digital gateway to swift advice—now keeps callers on hold for over eight minutes on average, a jump of 576 % compared with 2024.
Professionals Adored, Administrations Blamed
Despite the gloomy outlook, doctors, nurses and auxiliary technicians retain the public’s trust, with 57 % expressing satisfaction with their work. The same cannot be said of the political leadership. Two-thirds of respondents fault the government and 57 % single out the current Health Ministry for mismanaging resources. Analysts see a familiar pattern: citizens separate the human face of the SNS from the bureaucracy that funds and organises it. That distinction keeps protest pressure squarely on policymakers—from local council halls to the Assembleia da República—rather than on hospital wards already stretched by overtime.
Why Most Families Still Stick With the SNS
An obvious escape route would be private insurance, yet 4 in 10 Portuguese say they feel no urge to buy a plan. Several motives converge: commercial premiums have climbed faster than wages; group policies remain largely an urban, white-collar perk; and, crucially, private hospitals often depend on state contracts to reduce public waiting lists, blurring any neat public-versus-private divide. Household budgets help explain the choice. For 62.5 % of families, health spending consumes under 10 % of income, and Portugal already ranks high among OECD nations for out-of-pocket costs, which accounted for 30 % of total health expenditure in 2022. Paying twice—first through taxes, then again through premiums—feels like a luxury few can justify.
The Cabinet’s Prescription: Emergency Plan, Year Two
Aware of mounting impatience, Lisbon rolled out an Emergency and Transformation Plan for Health last year and is now accelerating it. Contracts with social and private providers aim to secure family-doctor coverage for 1.5 M users in medical deserts such as Lisboa e Vale do Tejo and the Algarve. A parallel push seeks to channel all non-oncology surgeries exceeding legal wait times to outside facilities by August. Another legislative tweak established 39 Local Health Units (ULS), merging primary and hospital care under one roof to cut red tape. Early data hint at progress: the average delay before surgery dropped to 301 days in 2025 from 516 in 2024, and winter emergency wait times fell by over 20 %. Yet hospital managers warn that the backlog remains stubborn, with 75,000 cases still breaching deadlines in March.
The Staffing Drain That Won’t Go Away
Infrastructure alone cannot heal the service if talent keeps leaving. Between 2023 and mid-2025, more than 3,000 physicians resigned from the SNS. Retention proposals under discussion include exclusive-contract bonuses of 40 %, new training slots in the fledgling specialty of Emergency Medicine, and ceilings on what freelance doctors—known locally as tarefeiros—can earn per shift. Nurses’ unions, for their part, demand a recalibrated pay scale and permanent contracts to replace rolling short-term deals. Whether these measures arrive fast enough to staff operating theatres next summer is the question haunting regional health authorities from Braga to Faro.
What to Watch Next
For people living in Portugal, the stakes are more immediate than any policy debate in Lisbon. The yardsticks are simple: shorter waiting lists, quicker phone assistance and a doctor who will still be there next year. The government has promised visible gains by the end of 2025. If those promises materialise, the public mood may turn. If not, conversations in cafés will grow louder—and far less forgiving—about the state of a national treasure they are not yet prepared to abandon.
