Over €1.2 million is owed to the Algarve’s public hospitals by foreign patients who used emergency services but never paid, according to a new report.
The findings come from the national inspection board of health activities (IGAS), which warns that Portuguese hospitals are failing to property control and recover costs linked to non-resident foreign patients. In many cases, the bill is let to the national health service (SNS) – in other words, to taxpayers.
In 2023 and 2024 alone, Algarve hospitals issued invoices worth €2.35 million to foreign patients who were not covered by agreements or insurance. More than half – €1,234,358 – remains unpaid.
Over those two years, more than 26,000 emergency episodes were recorded for non-resident foreign patients. Of those, more than 14,000 were never paid.
Under current rules, foreigners from countries without healthcare agreements with Portugal, and who have no private insurance, must pay the full emergency fee. According to IGAS, that ranges from €51 for a basic emergency, €85 to €90 for an intermediate case, and €112 for the most serious emergency visit, with additional costs added for exams or further treatment.
By contrast, foreign citizens covered by bilateral agreements pay only the standard user fees, which range between €14.16 and €18, depending on the type of emergency.
IGAS says one of the main problems is the difficulty in identifying who is responsible for payment, with the Algarve health unit (ULS Algarve) citing the complexity of tracing the correct entities. Inspectors also note that charging after treatment increases the risk of non-payment.
But the Algarve is not the only area facing unpaid bills by foreign non-residents. IGAS carried out audits at the ULS do Oeste and at Hospital de São José in Lisbon, also finding collection difficulties. In the Oeste region alone, more than €70,000 is reportedly unaccounted for, with inspectors highlighting serious weaknesses in accounting systems that do not properly track the individual costs of foreign patients.
The issue has already been debated in parliament amid concerns of growing debt and weak enforcement. In November last year, the Health Minister admitted that around 40% of foreigners treated in the SNS had no payment coverage, and that debts were mounting.
A previous IGAS report in 2024 found that more than 140,000 non-resident foreigners accessed the SNS without agreements or personal insurance, raising the possibility of millions of euros in unpaid bills.
In its latest report on the Algarve, IGAS warns of “high values” lacking effective control and recommends stronger procedures to ensure payment, including the possibility of charging patients upfront when they arrive.
Source: CNN Portugal
