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Cancer Treatment in Portugal
How good is it?
If you are considering a move to Portugal or are already living here, you may have some concerns about the quality of cancer treatment in Portugal, especially if you have a family history of cancer, or if you are a cancer survivor or currently in remission. The subject came up a few months ago during a conversation with a group of expat friends living in Portugal, and I thought it was an interesting topic, so I decided to do a bit of research.
On a personal note, I have not had to access healthcare in Portugal for cancer, so I don’t have first-hand experience. During my research, I found plenty of information on cancer treatments in Portugal but not a lot about the quality of cancer care. So, I asked a few expats living in Portugal to get unbiased and independent views and opinions.
This article is a high-level overview and focuses on the quality of cancer treatment in Portugal. It does not go into the details of what private or public health insurance will cover. At the end of this article, you’ll find resources for health insurance and other health services in Portugal.
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Accessing healthcare in Portugal – a brief overview.
There are three access points to healthcare in Portugal:
National Health Services – the public healthcare system is commonly known as SNS or Serviço Nacional de Saúde. Although many consider the public healthcare “free” it is paid for by the citizens and businesses of Portugal in the form of high taxes and Portuguese workers’ social security contributions.
The public health system applies to mainland Portugal. Madeira and the Azores have their own healthcare systems.
Depending on what country you’re coming from (primarily from the European Union via the European Health Insurance Card), you may be automatically eligible to access the public health system in Portugal.
For some non-EU countries such as the Republic of Cabo Verde, Morocco, and Brazil, where Portugal has reciprocal health care agreements, the public healthcare system in Portugal can be accessed.
For those who are from other countries such as the United States, you can only access the public health system after you have your residency card.
Health Subsystem Program – this program provides health insurance for specific professions such as Portuguese police, military, and public servants.
Private Health Insurance – This is health insurance that you pay for. There are several types of private health insurance with various levels of coverage – however, the choices for private health insurance becomes more limited once you’re over the age of seventy.
The advantages of private health insurance include having access to private hospitals and clinics. Wait times are generally less than in the public health system where wait times can be weeks or months depending on the type of health service needed. Many expats feel that it’s their responsibility to maintain private health insurance because they have not paid into the public health system in the form of social security. And most Portuguese citizens cannot afford private health insurance, so the public system can and frequently does become overburdened.
Many expats use a combination of private and public healthcare depending on the type of health issue. Although not mandatory once an American becomes a foreign resident of Portugal, evidence of private health insurance coverage is a requirement at your SEF (Immigration and Borders Service) residency permit appointment. The logic behind this requirement is that newly arrived expats who are ill or may become ill should not be a burden to the Portuguese public health system upon arrival. Please note that U.S. Medicare is not an acceptable form of private health insurance in Portugal.
Although you can visit a public healthcare facility if you become ill as a visitor or short-term tourist, you cannot access the free benefits of public healthcare (you will have to pay out-of-pocket), which is why travel insurance with medical coverage should be considered for a trip to Portugal.
The International Agency for Research on Cancer reported that there were over 60,000 new cases of cancer in Portugal in 2020 as shown on the chart below:
Uneven Distribution of Health Resources.
In a 2017 Country Health Profile from the European Commission, it was reported that the distribution of health resources in Portugal varies across the different regions of the country and its municipalities. There are also disparities in access to general healthcare with significant differences in wealth and health indicators between the greater metro areas of Lisbon and Porto and interior areas of the country where many people live in rural, poorer communities. This diagram shows the different regions.
In 2018, the healthcare system in Portugal ranked 13th in the 90-page Euro Health Consumer Index and the country continues to make improvements in outcomes for cancer treatment as well as several other categories of health issues.
How good is cancer care in Portugal?
As mentioned previously, I don’t have personal experience in this area, so I conducted an informal poll of expats living in Portugal asking the following question:
“I’m looking for insights from people who may have had cancer treatments in the States and have also used an oncologist in Portugal for treatment and care. What was the difference between the quality of oncology treatment/care in the U.S. and Portugal? Better? The same? Worse?”
It’s interesting to note that none of the answers I received were completely negative and most were positive. You should take this information for what it is (the informal opinions of others), and it should not be a substitute for your own research.
Here are some of the answers I received (some who answered didn’t answer the question but rather made suggestions regarding health insurance, so I eliminated those. I have edited and abbreviated the comments for the sake of clarity and privacy).
“All available treatments for cancer can be found in Portugal. Both the public and private system perform very well in this area. Portugal has higher survival rates in at least five types of cancer than the EU average.”
“I am from a country other than the U.S. but have lived for many years in Portugal. I have never had cancer treatment in the U.S. but am just coming to the two-year mark of a cancer diagnosis here and have had amazing treatment.
I have had several friends who went through the Champalimaud Clinic Centre and the treatment level is amazing. My oncologist is the head of the Portuguese Oncology and speaks perfect English. I cannot say enough about the level of care and how efficient and quick everything went along.”
“I was diagnosed and treated in another country where there is only private healthcare available. So, moving to Portugal, I had lots of questions. However, I feel that the service is even better, and I was told that if I must have chemo again, I would be referred to the public system as they are better equipped. For check-ups, however, the private system if you choose it is quicker.”
“It all depends on the type/location of the cancer. Portugal has great medical strength treating and aftercare of certain types of cancer but lacks greatly in others. I would not recommend Portugal for cancers of the neck and head.”
“I have experience with cancer treatment both in the U.S. and in Portugal. I used various hospitals in my home state where I lived as well as research hospitals including Mayo Clinic for support in several ways.
In Portugal, I used Champalimaud Clinic Centre for all consulting/scans/directions, etc. but stuck to the local public hospital for chemo since the private insurance I had didn’t cover pre-existing conditions.
The private consulting plus public chemo worked very well as the latter followed the direction of my private oncologist.
In Portugal I worked in this way for several months. That all being said, a few observations:
The chemo in the public system is just as good and efficient as the private. You get a personal television, free drinks, easier communication (with the private), but frankly, that’s it. It’s the same four hours in a chair in either place attacking the cancer which is the goal.
My designated oncologist in Champalimaud Clinic Centre was truly excellent. His demeanor through a tough time was incredible and a source of strength. He would speak in English as well as answer my many questions. He was also aware of research going on that other oncologists were not aware of.
In the U.S., it was only about the chemo in treating cancer. All very efficient certainly, but there was never any discussion of alternatives (diet, vitamin C drips, heat wraps, etc.). In other words, anything outside of drugs that might help the journey was left to my own research.
The cost for cancer treatment in the U.S. was overwhelming. I had good insurance fortunately, but I knew the costs compared to the costs in Portugal. All scans, chemo, etc. were a factor of five times more expensive in the U.S. If you have good private insurance or use the public health system here in Portugal for everything other than consulting, you’re fine.
Insurance here may not cover pre-existing conditions, but consulting doesn’t fall under this, so for nearly all the time I went through treatment in Portugal, I paid 15 Euros for each consultation at Champalimaud.
Once I started using the public system, it could sometimes take a little longer to get the appointments if needed. The chemo was firmly scheduled so that was fine, but when treatments were altered, I would need to see the public oncologist before the revised treatment started (he would also have to contact Champalimaud to confirm). Minor frustrations, but more than manageable.”
Private Health Insurance Resources.
These are three resources for private health insurance that I personally contacted when Paul and I were researching available options. I’m not endorsing these resources, but merely providing them for information purposes. These resources were helpful, had English-speaking representatives and answered all of our questions.
AFPOP (Portugal Foreign Residents Association) – AFPOP has an agreement with MEDAL for health insurance. Since not all health plans accept people over 70 years old, choices are slimmer for good private health insurance coverage. MEDAL insurance accepts people over seventy. You must join AFPOP (minimal annual dues) to access the health insurance through them.
Portuguese banks – Some banks in Portugal also offer health insurance. If you have a Portuguese bank account, you can inquire about private health insurance options. Rates could be higher through banks, so always shop around and obtain multiple quotes.
Health Services Resources in Portugal.
Botton-Champalimaud Pancreatic Cancer Centre - the first Centre in the world designed and built specifically with the aim of researching and treating pancreatic cancer.
CUF Hospitals - This is where patients with private health insurance go.
Champalimaud Clinical Centre (CCC) - The CCC is structured into Multidisciplinary Pathology Units (MPUs). These include, among others, medical oncologists, surgeons, radiotherapists, radiologists, pathologists, geneticists, nuclear medicine specialists, nurses, psycho-oncologists, nutritionists, physiotherapists, and palliative care experts, who meet regularly to define personalized diagnostic and treatment plans adjusted to each individual patient.
Hospital List - a list of the hospitals in Portugal.
Hospital da Luz - Another hospital network where private health insurance patients can go.
Portuguese Institute of Oncology Lisbon (IPO) – A state-run cancer hospital and research organization. It was founded in 1923.
International Agency for Research on Cancer (Portugal)
Serenity – Medical Concierge Services. Care coordinators especially for expats in Portugal. Services include finding the best provider in your area, the best place for labs or medical appointments, locating providers that speak English, booking appointments on your behalf, speaking on your behalf with pharmacies, doctors, hospitals. Annual membership fee for this service.
Are you already living in Portugal? Have you had positive or negative experiences with the quality of the Portuguese healthcare system for cancer treatment? Do you have additional resources I have not listed? Leave a comment and tell me about it.
Until next time…
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