With spending having increased significantly in recent years, in 2025, the National Health Service (SNS) accounted for an expenditure of approximately 18 billion euros. This includes an additional 1.378 billion transferred to hospitals in the second half of the year, an amount roughly equivalent to the expected revenue from personal income taxes (IRS).
Despite this, access difficulties persisted, especially due to the lack of general practitioners and specialists sufficient to ensure the normal operation of obstetrics and gynecology emergencies, constraints that mainly affected Lisbon, Vale do Tejo, and the Setúbal Peninsula.
Considered one of the causes of increased emergency pressure, the shortage of general practitioners persisted in 2025, with 1,542,989 patients without an assigned general and family medicine specialist in October, representing a slight reduction of 1.3% compared to January, about 21,000 fewer people.
This shortage was also contributed to by the highest number ever recorded of patients registered in primary health care, surpassing 10.7 million, which is about 200,000 more than at the beginning of the year.
Faced with this difficulty, the government’s response involved the opening of health centers managed by social and private sectors, which did not materialize this year, as well as conventions with family doctors working in the private sector.
At the hospital level, 2025 saw the generalization of pilot projects for telephonic referral of patients and pregnant women to focus emergencies on truly severe cases, but instability in obstetrics and gynecology persisted, particularly in hospitals in the Setúbal Peninsula. The Ministry of Health acknowledged this difficulty and plans to address it by creating a regional emergency service.
Emergency closures due to the lack of doctors for shifts also brought to light cases of births outside hospitals, often in fire brigade ambulances, which have increased in recent years. According to INEM, from January to October this year, 45 births occurred in ambulances, 17 more than throughout 2024.
The cases of pregnant women visiting several hospitals before being attended to led to unions and parties calling for the resignation of Minister Ana Paula Martins, who consistently dismissed this possibility, stating she would assume responsibility by solving the issues.
Regarding births outside the hospital — in ambulances, public places, and at home — INEM reported to Lusa that in the first 10 months of this year, 186 cases were recorded, roughly the same number as the 189 of the previous year.
Throughout the country, figures from the Executive Directorate of the SNS indicate 600 fewer emergency closures from January to October this year compared to the same period in 2024, with the most significant decrease occurring in general emergencies (down 70%) and pediatrics (down 53%), while obstetrics saw a 30% reduction.
This year, the government introduced regulations to discipline the activities of doctors not contracted with the SNS, who provide task services in hospitals. Additionally, failures in the SIGIC exposed cases of high payments for surgeries performed outside working hours, prompting the government to implement a new national system for access to consultations and surgeries (SINAAC).
After years of recovering from the pandemic’s impact, in 2025, the SNS recorded an increase in care activity in most indicators, but also a growth in waiting lists for consultations and surgeries.
The first hospital consultations increased by 4.4%, resulting in more patients being referred for surgeries, leading to an 11.9% increase in the waiting list compared to 2024.
This year, the number of patients operated on grew by 4%, reaching 604,197 surgeries, about 21,000 more than the previous year.
Regarding oncological surgeries, after the conclusion of the OncoStop program, the waiting list grew by 21% due to more patients being referred, with the number of operations also rising by 3% compared to the previous year.
In terms of pre-hospital care, 2025 was the year INEM awaited a yet-to-be-implemented restructuring and was under scrutiny by the Health Activities General Inspection (IGAS), with investigations into the deaths of 12 people during a strike at the end of 2024, associating three of these to delayed assistance.
Additionally, the institute coordinating pre-hospital emergencies, which saw military officer Sérgio Janeiro replaced by physician Luís Cabral as the head, was compelled to resort to the Air Force to support the emergency transport operation. This happened after the company that won the contract failed to provide all the helicopters in July, which only occurred four months later.
The year began with the resignation of the SNS’s executive director, António Gandra D’Almeida, with economist and university professor Álvaro Santos Almeida taking over as head of the entity that manages the public health institutions network.
