The Cost of Portuguese Medicine
My Experience to Date
I apologize if my posts this week seemed self-indulgent. It was not my intent. Rather, for those of you that have not yet landed in Portugal, I wanted to share with you what you might expect from Portuguese healthcare.
As part of the D7 process, we secured six months of travelers’ insurance. We utilized a company called Swisscare for a policy that met all of Portugal’s requirements. Of course, the cost of this policy is based on your age. In our case, as 66-year-olds at the time, the cost was under $300 for both of us for the entire 6 month period.
As we prepared for our SEF meeting, it was recommended that we get “private insurance”. While I worked in healthcare and I am very familiar with healthcare billing in the States, I must admit reviewing insurance policies makes my eyes cross. We reviewed three different plans and settled on a "middle-of-the-road” plan that cost us €290,19 a month (for both of us). When we see a physician our co-pay is €18. (Like our cable bill in the US, I may not have found the cheapest alternative.)
Prior to the accident I saw a physician and had X-rays as part of that visit. The total copay (office visit and X-ray) was €35. [I will admit, we were a bit spoiled in the States. We paid $148/each for Medicare Part B and had Tricare for Life as our supplemental policy. We never paid out-of-pocket to receive care. But we know not everyone is as fortunate. We continue to pay for Part B because if we were to return to the States we would have to make all back payments to be eligible. I suspect in the not too distant future we will stop paying for Medicare Part B.]
I will also admit that I am not an expert on Portugal's SEF requirements. I know of people that have gone to their SEF meeting with no more than the traveler’s insurance that they arrived with. However, I have been told by expats and Portuguese citizens that if you can afford private insurance buy it because you will receive non-urgent, specialty care more promptly than in the public system.
More to the point, what did last week’s care cost?
As it turns out Portugal insurance companies have learned about the wonders of pre-authorization. When I left the hospital on Monday, I was told they had filed the necessary documentation with my insurance company. Typically it took 3 days to get the approval and I should follow up with the insurer. I did call the next day, but unfortunately, they did not have a “Press 2 for English” option. Later that day I received a phone call from the hospital billing office. They explained that the insurance company (MGen) had not yet approved the surgery. As such I would be expected to pay €3750 upon admission.
While I was more than willing to do that, I was unsure what I should do. I called the insurance agent that had sold me the policy. Frankly, she went above and beyond anything I could have expected. Every few hours she called the insurance company urging them to expedite the pre-authorization process. When they told her I needed to document how the accident had occurred, she contacted me and translated for me the documentation they required.
As it turns out my surgery was approved by the insurance company after I was admitted but before I was discharged from the hospital. Today I noticed that the hospital had issued a refund to me. (In all I paid about €500 euros for this surgery. The second surgery is less…but I am keeping my fingers crossed.)
It is difficult to compare US and Portuguese costs. First, in the US we separate physicians (Part B) from hospitals (Part A). We also need to add up multiple bills as the radiologist and anesthesiologist may bill separately.
But it would appear that had I not had private health insurance and wanted to use the private system this episode would have cost about €4000. That includes a visit with the orthopedist, 2 Xrays prior to admission, EKG, blood and Covid tests, surgery with Xrays, anesthesia, and one night in the hospital. I estimate it would have been at least $20,000-$30,000 in the States. I also met this week with another American expat that had her gall bladder removed last week. She paid €200 because she had insurance, but would have only paid €3000 had she not had insurance and utilized the private system.
Why is it so inexpensive (when compared to the US)?
First, the CUF facility does not have a marble foyer and I don’t think Marriott is the caterer for their cafeteria. Sorry to be so glib but it is true. Having worked for a company that also sold medical equipment I have some feel for how much money US hospitals “waste” for this year’s model of an MRI or CT Scanner. You likely can make the same diagnosis with 48,000 slices as you can with the more expensive 64,000 slice model. But if there is not an incentive to save money, and you can pass on the cost…why not?
While I don’t know exactly what physicians make in Portugal I doubt it is $441,000/year which was the median physician compensation in the US in 2020. (Yes, I research these things.) When you consider that many Pediatricians and Family Physicians are making $150,000 (and $441,000 is the median) you can estimate how much some US physicians are making.
Third, I am certain because salaries are lower here, nurses and other health care personnel are also less expensive.
Finally, there are what I will call reasonable cost-cutting measures. I was told to bring with me any prescriptions I routinely take. My one Gabapentin tablet in a US hospital would have cost a lot more than it cost me, been marked up, and then added to my bill. So would my toiletries…which I was told to pack.
Fundamentally though, our systems reflect the economic systems within which they were created (capitalism vs. socialism). This, along with the fact that more than 1 in every 10 private-sector workers, work in health care in America speaks to the difficulty in flattening the health care inflation curve in the States.
Public - Private
At the end of this month, Denise and I will both complete our SEF meetings. At that point, we will become temporary residents of Portugal and eligible for the public health system. We could stop paying for private insurance. But as we are not paying Portuguese income tax at this point, and as we can easily afford the insurance premiums, we will continue to pay for private insurance.
It is not that we think that the public system is inferior. We have learned that for certain specialized care the private system actually refers to and utilizes the public system as it is better equipped to handle that type of care. We just don't want to burden a country with the cost of our care when we are not contributing to the tax base that supports it.
If you have experience with health care in Portugal … public or private, please share your thoughts, or comment below.