A TRAVELER’S VIEW FROM HIS NEW HOME
One Transplanted American’s View of the Portuguese Public Healthcare System
I live in Portugal now. It’s even better than I expected.
Context
For a wide variety of reasons, all having to do with quality of life, I moved from California to Portugal several months ago.
I live here on a D7 visa, which many refer to as a pensioner’s visa. However the term “pensioner’s visa” is a misnomer. The D7 is more accurately a visa for those with passive income.
Anyone, yes anyone, at any age, with sufficient passive income can apply for and obtain the D7 visa. The amount of passive income one must demonstrate is low by US standards, about 10K annually in US dollars for an individual. Social security, pensions, rental income, other investment income, and the like all are forms of passive income. I qualify for the D7 primarily because I collect social security.
With a D7 visa one can live legally in Portugal for two years initially. Then, one can reapply and, if approved, stay for another three. Thereafter, one can either become a citizen and remain endlessly or continue to live in the country as a permanent resident required to re-up every five years.
The citizenship path also involves taking free Portuguese language lessons offered widely throughout the country and passing a series of tests offered by the language-teaching centers. The citizenship route is what I’ve got currently planned.
The benefits of living in Portugal go on and on, stretching seemingly-infinitely into the future. I’ll save those for another story.
But I do enjoy three tangible perks as a temporary resident with a D7 visa: * The legal right to work in the Portuguese economy * Free or low-cost university education * Free access to the Portuguese public healthcare system
I’ll talk about my experience with the Portuguese public healthcare system here and save the other two treats for other stories.
Portuguese Public Healthcare — One Man’s Perspective
I’ve already dropped my US-based Blue Shield coverage. Shortly Medicare will go by the wayside as well. Neither covers me in Portugal.
Even if I became seriously ill I would not return to the US for medical care. The care here is considered excellent (do your own investigations if you doubt me). I can’t see boarding a plane and flying into the maelstrom that is the US healthcare system, especially in the midst of a health crisis. Home is now here in Portugal. Home is where I’ll get my healthcare if and when I need it.
I’ve already alluded to the fact that the quality of the medical care I’ve received has been excellent. This in spite of a few bumps in the road gaining access to that care.
The “bumps” occurred because — just like big systems worldwide — the Portuguese system isn’t immune to bureaucracy or individual employee incompetence. Thankfully though there’s no insurance industry standing between me and the care I need and the doctor thinks I should have. There are just local rules and regulations and some employees who could do with some additional training. As mentioned … bumps in the road, not roadblocks.
One other theme worth mentioning.
That is the Portuguese tendency — at least as experienced multiple times by this American — to reply to every question in the negative, a flat “no”, without explanation or further attempt to problem solve.
I’ll give one example, of many I could cite.
Me: at the pharmacy holding up a nearly empty bottle of my prescription medication, “Can I get a refill of the pills in this bottle?”
Pharmacist: “No.”
Me: “I was told I could get a prescription refill here just by bringing in my labelled medication bottle.”
Pharmacist: “No.”
Me: (rather than getting frustrated and leaving, and already attuned to the Portuguese “no” and sensing I was not yet asking the right question) Why?
Pharmacist: “We don’t sell pills in bottles.”
Me: (a glimmer of understanding dawning) “How do you sell them?”
Pharmacist: “In boxes.”
Me: “Can I get a BOX of the medication (that I’m waving around in front of your face?)”
Pharmacist: (smiling broadly) “Yes.”
Interactions like this happened repeatedly as I navigated the Portuguese public healthcare system for the first time.
But, on to my clinic visit(s)
I went to the local public health center and presented my D7-based temporary, long-term, resident card. Welcome to the system I was told, we need a few documents to sign you up for care.
Document copies were made and I was given an official-looking piece of paper granting me healthcare system access … or so I thought.
“Would you like to see a doctor now or tomorrow?” I was then asked. Remember, this is as an American new to the country trying to access the FREE PUBLIC healthcare system for the very first time!
After picking myself up off the waiting room linoleum I answered that tomorrow would be fine.
Tomorrow came and I reappeared. After waiting minutes I was welcomed into a professional-looking doctor’s office by a professional-looking doctor.
Following introductions I explained my issue. The doctor understood and immediately asked a few key questions about associated symptoms all focused on ensuring I was in no danger of death or serious health decline. (And I should know. As a retired ER Doc I’ve done the same a million times.)
Then he stated matter-of-factly “I can’t help you.” (or words to that effect)
“Why not?” I asked.
“You don’t have a blah-blah-blah number and the computer system won’t allow me to order any diagnostic evaluation for you. As we both know, you need … (And he reeled off an extensive laundry list of every medical test known to man he was planning to do to evaluate my issue. I was impressed.)
He noted items I hadn’t thought about since med school, all of them reasonable and WAY, WAY, WAY more sweeping in scope than any evaluation I’d had in my US life for the same issue.
“All I need is for you to get a blah-blah-blah number and we’ll proceed. Please go to the front desk again and explain, then I’ll be happy to see you.”
I returned to the clinic’s front desk and met another employee.
“Oh no,” he said. “The first person you checked in with told you the wrong thing. You’re not enrolled in the healthcare system. You can see a doctor but the doctor can’t do anything. In order for him to do something and for you to be ACTUALLY enrolled in the system you need a blah-blah-blah number.”
“OK,” I said, mildly amused. “I thought I had one of those but I guess I don’t so how do I get one?”
“You need to go to City Hall,” employee #2 continued. “You need a letter from them stating that you’ve lived here for several months.”
I was provided directions to (wrong) City Hall and off I went … to the wrong City Hall.
Days later, after a tour of several City Hall offices at the wrong City Hall and one brief visit to the right City Hall office at the right City Hall I had my letter.
Back to the clinic I went.
With the magic City Hall letter I got my blah-blah-blah number and another appointment with the doctor.
“Oh, I don’t need to see you again” the doctor explained when he saw me. “The front desk could just have given me your blah-blah-blah number. You and I both know you need …” and again he rattled off the incredible, and incredibly extensive and expensive, series of tests he had planned to address my issue.
So, I left.
A few days later I received a call from the clinic. “Please come by and pick up the paperwork for all the tests you need.”
I did.
And the same helpful guy, employee #2, the one who seemed to know what he was doing, told me where to go for all my tests. All would be locally done except one because a needed local machine was broken and has been for a year. No prob — I can go to neighboring town for one test. I understand that machines break. A year seems a bit long for medical machine repairs but so be it.
As noted, Employee #2 told me where to go for my lab tests. He, of course, sent me to the wrong location. Three re-directs later I was at the right place and got my lab tests done, smoothly and professionally.
Of the 52 lab tests done, four had to be sent (far) out of the area for processing. (I live on a tiny Portuguese island in the Atlantic.)
I had all results in hand within a week.
The extensive lab testing was mostly free but several tests were so obscure and infrequently ordered that I got charged 127 Euros. One other non-lab examination (costing thousands in the US) cost me 100 Euros.
Now, with all results in my possession, and reassuringly normal, I’m preparing to see the doctor again next week. I’m confident he’ll provide excellent advice and a clear direction on how to proceed from here.
What have I learned so far?
- Worldwide, some people just don’t know how to do their jobs correctly.
- Incompetent people can be dealt with successfully if one is patient and persistent (knowing the language and the culture helps, I’m sure).
- Bureaucracy is present worldwide and is a real problem especially when one doesn’t know the culture or speak the language (yet).
- Bureaucracy can be overcome with patience and persistence.
- “No” is never the right answer although it may be the first one offered.
- Good doctors and competent lab techs working at competent labs exist in Portugal and probably most everywhere.
- Portuguese healthcare professionals seem to be excellent although the system and some of its other employees could use some work.
- I’m delighted to have access to free health care as a benefit of living in my new home country.
- I may or may not learn about the private Portuguese healthcare system. It’s inexpensive to get private health insurance here but it seems unnecessary for now.
End note:
I still have travel insurance that includes hospitalization and repatriation to the US. It’s cheap and covers me outside of Portugal. I’ll keep it for now. As noted, I can’t imagine being repatriated to the US for any reason but it’s useful if I need it when I’m away from my Portuguese home.
For another US perspective on healthcare across the border in Spain: