An audit requested by the government on the National Institute of Medical Emergency (INEM) highlights issues of transparency and accountability among financial beneficiaries such as firefighters and the Red Cross. The report, covering the period from 2021 to 2024, indicates potential contractual breaches by partners within the Integrated Medical Emergency System (SIEM).
The audit reveals that funding for firefighters and the Portuguese Red Cross was based on various protocols and ad-hoc decrees, sometimes lacking normative framework, and identifies significant weaknesses in the subsidy verification processes for agreed-upon resources.
Out of the 75,492 pending documents from partners, a commitment has been made by the institute to develop a platform to handle these issues, with the oldest documents dating back to 2022.
The absence of communication mechanisms with other public entities that also provide grants indicates a risk of double financing or overlapping of financial support, according to the audit.
INEM’s current transfers increased over the past four years, with last year’s transfers representing 53% (89.2 million euros) of total expenses. These transfers primarily fund the establishment and maintenance of Emergency Medical Posts (PEM) and Reserve Posts (PR), with the Humanitarian Associations of Volunteer Firefighters being the main recipients.
Based on the first four months of this year’s data, there might be a need to increase public funding or revise regulations to raise INEM’s share of insurance premiums to ensure budgetary balance.
“Given the current spending trend for 2025 and new commitments, the estimated own revenue (2.5% of premiums or contributions related to insurance contracts, as stipulated in its Organic Law) might be insufficient to cover all financial needs, including those related to the planned increase in human resources,” the audit notes.
Utilizing previous management balances may also prove essential for maintaining budgetary equilibrium, it adds.
The cost of INEM per citizen increased by over 45%, from 11 euros in 2021 to 16 euros in 2024. The cost per assisted patient rose 29%, from 91 euros in 2021 to 117 euros last year.
Without significant demographic shifts, the rising per capita cost of the pre-hospital emergency service largely stems from updated protocols with the Firefighters League and increased costs of goods and services, urging the need for savings to ensure more economical resource management.
The recent cooperation agreement with the Portuguese Firefighters League is projected to have a 25.2 million euro financial impact, not fully covered in the 2025 budget, potentially necessitating budget reinforcement.
The agreement is contingent on studies and adapting essential records and systems, including enforcing penalties.
Regarding crew requirements and ambulance certification, there is a lack of systematic and regular procedures for assessing PEM and PR activities, including pre-hospital emergency effectiveness and quality.
In 2023 and 2024, there were over 2,000 refusals to deploy resources and more than 18,000 cases of inoperability due to protocol breaches, lacking penalties for such occurrences.
