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Cautionary tale about the Portuguese healthcare

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Aleo
  2/21/2023 09:12 EST

This story will be useful for people who are considering moving to Portugal and for those who already moved.

I relocated to the Algarve from the US about three years ago. When I was researching Portugal (and the Algarve in particular) I naturally paid much attention to healthcare. From the research and, later, from talking to other expats, I got an impression that Portuguese public healthcare is okay, but very slow, however, having a private insurance solves all problems - modern hospitals, good doctors, fast service...

My story started in July 2022 when I had COVID and right after that I got an enlarged armpit lymph node. From what I had read, it is a quite common side effect of various infections so I waited about two weeks before I started to get worried and went to see a doctor in a large local private hospital, which is part of one of the biggest (or, maybe, the biggest) private hospital chains in Algarve.

And then the problems started... Here is how the process looks like in a private hospital here. You schedule an appointment with a doctor and after several days, you see the doctor who writes you a prescription for a test or an exam and tells you to come back when you receive the result. You need to schedule this test (and the process of scheduling itself sometimes takes a week), then you wait for a test (another several days), then you wait for test results (could be another week or more), then you schedule the doctor appointment to discuss the results and the next steps, then you wait for the appointment, then you visit the doctor, and the cycle repeats.

It is common here for hospitals to not answer the phone, or if the hospital has a dedicated call center, they do answer the phone after some time on hold, but they can only answer very basic questions; for everything else they connect you to the corresponding department in the hospital, where the phone is not answered. There are no direct incoming phone lines in these departments, so going through the call center is unfortunately the only way. You can get their email addresses, but I have never received a response to my numerous emails.

It took me more than two months to get to the point where I had results of the biopsy of my lymph node and by that time it was a metastasized melanoma, which is quite a deadly cancer.

The doctor was very sympathetic and he told that he will bring my case to the oncology meeting in the hospital in two days and will call me back with the further instructions right after the meeting. Guess what - he never contacted me! I received a call from the reception after more than a week, suggesting to schedule an appointment with an oncologist.

By that time, I found a doctor in a large private hospital in Lisbon and within five days from the doctor's visit I had three CAT scans, some nuclear medicine exam, and had a major surgery removing the tumors they've found so far.

The point of this story is two-fold:

* If you are considering moving from the US (I don't have experience with the healthcare in other countries) to Portugal, think hard about the healthcare. Don't get carried away by the stories of expats who didn't have any serious medical issues. On the surface it looks marvelous: the private hospitals are new and shiny and the healthcare here is extremely affordable - I pay for private insurance (several hundred per year) and they cover 90% of most services. CAT scan with interpretation costs 10 euros and a major 5-hour surgery with two nights in the hospital cost me less than 600 euros. But be aware that if you have a serious and urgent problem, your mileage would vary and you may be risking your life! If it is serious but not urgent, you can probably go through all the bureaucracy and go to a different country for treatment, but it would take time to arrange it.

* If you already live in the Algarve or other peripheral area, go to Lisbon (or probably Porto) for all your healthcare needs. Portugal is a small country and it would not take much of your time and money to go to Lisbon. After my experience, I would not trust Algarve hospitals with an annual health check-up. And the situation here seems to be deteriorating every month: it is already a catastrophe in public hospitals (someone recently waited 28 hours in the emergency room!), but the availability of the doctors in the private hospitals gets worse too.

DavidDT
  2/21/2023 09:31 EST

Health care "specialists" in Algarve are just like AL owners - they do quick hit and run rent collection by moonlighting in private hospitals for high season (instead of doing their job in public hospitals they are paid for) and then they are nowhere to be found for the rest of the year spending this money on drinks while laughing at silly ???
The bottom line is - Portugal is "oversold"

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Skillmaa
  2/21/2023 13:52 EST

Frankly, I have worked in health care in the US (Chicago) and this sounds just like process here. It's really going downhill here in the states.
- I haven't been able to schedule an appointment with primary MD. Called to schedule in December, next opening was May. Was sent to Immediate care who sent me to Emergency, xray, scan.. told to follow up with primary. Still have the problem, still waiting until May. I have pretty good insurance through work and so far have spent over $900 in copay for this one episode. Leg is still swollen with nerve pain, I guess I'm still alive so it can wait. I managed a large clinic for several years in the 90s and it wasn't like this.

Milford008
  2/22/2023 13:31 EST

Your cautionary tale was much appreciated. As Canadians - we have universal health care but are considering a move to Portugal in a year’s time.
We’ve been inquiring about the cost of heath care coverage and the range is wild.
Would you be able to share who you are receiving your healthcare coverage through?
Glad the outcome for you was positive after your long ordeal.
Stay well!

sunburst93
  2/23/2023 09:18 EST

I don't think this post gives an a fair and accurate picture of healthcare - private that is. I don't understand the points about having to make appointments, wait for results and then another appointment to discuss the results with the doctor. Surely this is the way it works in most countries? I know in the US I would make an appt to see a doctor, which could take up to 3 months in some cases if it was a specialist, then if they sent me for a test that depends on what kind of test. Pretty much scans or similar within a few days. Then assuming no terrible news, in which case you'd be called in immediately, your appt to discuss the results might be a couple of weeks later. Sounds pretty much the same as I've experienced here, also in the Algarve. All the doctors I've seen - and as a cancer survivor I have a few - have been kind and responsive and I believe professional in their care. Healthcare here may not be to the same standard as say a top hospital in NYC, but then it's not going to be in some small town in rural Arkansas or somewhere either. There is a top cancer research center in Lisbon where I had wonderful treatment but it only treats cancer patients. Private healthcare is very reasonable, my husband and I only pay 2600 Euros each for the year. It also covered my pre-existing conditions. And we're in our 70s btw.
.

Sunworshiper2
  2/23/2023 11:35 EST

Thank you for posting about your medical ordeal with the healthcare system. I'm sorry you had to go thru that & hope you're well & healthy now. I had planned on moving there last year, but I had health problems that kept that from happening. I will most definitely give this much consideration when I get back to my search on destination to live. .
Take care & thanks again.

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LouisianaGirl
  2/23/2023 11:44 EST

Sunburst 93, can I ask who your health insurance coverage is with? I am currently reviewing my options. My husband is 69 and I am a bit younger.

realspear
  2/23/2023 14:03 EST

". I don't understand the points about having to make appointments, wait for results and then another appointment to discuss the results with the doctor. Surely this is the way it works in most countries?"

Agreed. How does Aleo think this should be done? Give us insights. Do you think that the tests should be done before a consultation? No US insurance company would pay for that. Do you think the results are instantaneous? Tell us where the results can be obtained immediately so that you don't have to wait. Seriously, this is ridiculous.

I have had far better care and zero pushback from insurance (Allianz through Medal/AFPOP) for anything. I have had surgery five times since coming here, once emergency surgery, and it has gone really well. I have been kept in the hospital for something that people are routinely discharged for after surgery, and it was important as I was hooked up to stuff that was essential.

I had a heart condition that nobody in the US could diagnose since my first 'incident' at age 12 spotted, tested, and explained here.

I have had tests that cost $1800 with insurance in the US done for €9 here.

I trust my family doctor (Portuguese term for GP) far more than any doctors I ever saw save the last one in the US.

Prescriptions are subsidized by the government based on necessity. Insulin is free. Blood pressure medication that I take is less than a euro a month. Gout medicine is somewhat less than €2 a month. Try that in the US, even with insurance.

I have used the public system for services that at the time were not done in the private system. It was inexpensive and thorough.

Portugal makes US healthcare look like a major failure, I can't imagine going back given the conditions I need monitored.

Jkugs
  2/24/2023 12:03 EST

Healthcare rates are somewhat dependent on your age.
I am 69 I pay about $180 a month with MGen.
I don't have the lowest benefit or the highest, I am somewhere's in the middle.
I went with MGen for the following reasons.
No limit on renewability...my age will never disqualify me from renewing my plan.
They accept pre-existing conditions.
I used a service called Serenity to help me navigate the various healthcare providers. You can do this yourself, I just preferred not to.
If you join Afpop I believe you can buy MGen through them and get a discounted rate.

GeoffK
  2/24/2023 15:15 EST

Sorry for your experience and I hope treatment has been succesful. Please be more specific than "the Algarve". I live in Tavira and while I have not had any really serious conditions, I have been totally satisfied with the service from two different clinics in Tavira. I have friends who have been in hospital for treatment and have no complaints.

sunburst93
  2/25/2023 03:51 EST

To Louisiana Girl, we are insured with Allianz through AFPOP/Medal, like the poster who gave his positive view of healthcare. AFPOP is the Association for Foreign Property Owners in Portugal , you can join to get various benefits and discounts. Very reasonable to join. And Medal is the insurance broker you apply for insurance through.

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Aleo
  2/25/2023 15:48 EST

@Milford008

I have medical insurance from Allianz through Medal through Afpop. The insurance is quite good.

Aleo
  2/25/2023 16:58 EST

@sunburst93
@realspear

Let me give you an example to explain the difference...

Imagine that your doctor writes you a prescription for a biopsy with a needle. It is a relatively simple procedure that requires a doctor who can use a needle and an ultrasound device for guidance. In the US (or Lisbon, to that matter), you simply stop by the hospital reception and schedule this procedure for the next available date. It takes 5 minutes and you have an appointment with a date and time.

Here, it looked like this. The receptionist says "we cannot schedule it ourselves but we will forward your request to the corresponding department and they will contact you soon". Waited for 3 days, called the hospital call center (long hold). "What is the status of my procedure? Is it scheduled?” "No, but you should wait someone will call you." "Can I talk to someone who is actually doing the scheduling?” "Ok, can transfer your call to the department X". After a dozen rings the call is dropped. I am calling the call center back (10 minutes on hold) "What is the phone number of the department X?" "They don't have a direct phone number, so you have to call us and we will transfer. Transferring..." After a dozen of rings, the call is dropped. I sent them emails - no response. Several more calls - no success. After more than two weeks someone called me and told me the date. Waited a week, did the procedure (I had to drive to Faro from Portimao because it was the only place that had a doctor who could do this). "When the results will be ready?” "Should be ready in two weeks". After two and a half weeks, starting calling and emailing, no success - was not able to get any response.

After a month, I received an email with the report stating that the biopsy shows melanoma. The report was scanned and was signed and dated a week prior - so it was just sitting on someone's desk for a week before someone finally emailed it to me!

So it took them two months and most of this time was some bureaucratic inefficiencies. And my tumor was growing fast all that time, further decreasing my chances of survival.


In the US, when I needed a blood test or some other simple test, my doctor just walked me out of the exam room and either accompanied me or passed me directly to a nurse who walked me to the lab and the test was often done immediately (this was a rather small clinic). If it was something more complicated, the person in the reception made sure that everything is scheduled and she will call me, remind me, and so on. And of course I was able to call her any day and she would know the status of everything (or would find it out and call me back as soon as possible).

Also, when the results of a test were available and it did not require further discussion, my doctor would often shoot me a quick email. Here, I had to spend a week or more to make an appointment, then visit the doctor just to hear the same "everything is okay" message. I guess they wanted to get my 15 euros so much :(

So, my complaints are not about the steps that need to be taken (though I believe some of them can be short-circuited), but about the time every step takes and about the absence of basic customer service and communication. Can you imagine a private hospital that does not pick up their main phone line during the working hours?! We have one here!

And there are so many other crazy things... For example, after the surgery in Lisbon I was coming to the local private hospital in Algarve to change the wound dressing. With the insurance, this procedure costs me 10 cents! Well, to pay 10 cents you have to spend 30 minutes after the procedure waiting for your ticket to be called, while most of the dozen of the receptionists chat with each other. I asked them if I may pay online, or when I come next time, or pay more in advance, and the response was "no, according to our rules you have to pay after the procedure before you leave". Of course, it cost way more than 10 cents for them to process my payment. Just yet another stupidity that nobody has any motivation to fix.

Aleo
  2/25/2023 17:05 EST

@GeoffK

It is Western Algarve, in and around Portimao.

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