Portugal’s parliament has approved in principle two bills requiring foreigners who do not live in the country to pay for treatment in the National Health Service (SNS) or to show proof of insurance cover.
The vote, on October 16, brought together the governing Social Democratic Party (PSD), its coalition partner the People’s Party (CDS-PP) and the right-wing Chega, with every other party voting against. The texts still have to clear committee scrutiny and a final vote before they can become law.
The PSD-CDS bill would make access conditional on payment or on an insurance policy for non-residents and for foreigners staying in Portugal illegally. It would also oblige the State to identify who is liable for the bill and, where necessary, to demand a guarantee or advance payment.
Emergency treatment would still be given, though patients would have to produce the paperwork afterwards.
The Chega text, passed separately with support from the PSD, the CDS-PP and the Madeiran party Juntos pelo Povo, covers non-resident citizens of countries outside the European Union, stateless people, asylum seekers whose claims are still pending and migrants with no legal status.
A second Chega bill went further and was defeated. It would have obliged non-residents to pay in full on discharge and would have withdrawn fee exemptions from pregnant women without residence rights and from asylum seekers awaiting a decision, with the PSD abstaining.
Parliament also backed non-binding resolutions from the Socialist Party and the Liberal Initiative calling for tighter billing and collection, including an audit within 90 days of what care for non-residents costs the SNS.
The authors of the approved bills said more than 330,000 hospital emergency episodes involving non-residents between 2021 and 2024 had gone uncovered. PSD deputy Cristóvão Norte has put unpaid hospital bills in the Algarve, southern Portugal, at more than €1.2 million.
Similar measures were approved in the previous legislature but lapsed when parliament was dissolved. The issue returned to the front pages in September, after the head of the Amadora-Sintra hospital, outside Lisbon, warned of the pressure that health tourism was putting on maternity units.
The votes come as the Portuguese Government hardens its line on immigration, having agreed in January to pay €8.4 million rather than take in 420 asylum seekers under the EU migration pact.
Portugal, for years one of the countries in Europe most open to immigration, had about 1.5 million foreign nationals at the end of 2024, close to 15 per cent of the population.
