In mid-April, in the same week as attending a big conference in the Algarve, I started to feel unwell. I did a Covid test and it was negative. As a precautionary measure, I wore a mask (as I usually do anyway in any public space) and socially distanced. Even as a conference panelist, I ensured that fellow presenters and audience were meters away. Just in case…
On Friday of that week, feeling very unwell, I decided to take another Covid test, which was positive. Given my previous experience with Covid, and complications (that experience was documented here: Covid-19 An Undiagnosed Case – ALL ABOUT RETIREMENT OVERSEAS), I am always attentive to this terrible virus.
The first step – calling the national health line: Saúde 24
I immediately called the national 24-hour health line, called Saúde 24, on 808 24 24 24.
After being taken through a comprehensive set of questions by a nurse, it was determined, based on symptoms and previous Covid track record, that I would need to be seen urgently by a local health center.
I was allocated a health center in Lagoa and scheduled to pay them a visit in the late afternoon of that Friday. It was around 17:00. Just as I was getting ready to leave, I received a phone call from the health center letting me know that the doctor had not shown up for work, and that I should not make my way there. They suggested I call the Saúde 24 helpline again, which I did. The health line was unable to provide any alternative solutions, as there were no other available locations/slots on that evening or over the weekend. Literally, they were unable to offer any suggestions – not even the recommendation of going to A&E.
Accessing the private system due to lack of options in the public system, and for quick access to initial diagnosis
At this stage, I was left with two options: going directly to A&E, or trying to get a more detailed diagnosis via a doctor. I chose the latter route, because I was feeling very unwell and wanted to visit someone as soon as possible, and close to where I was staying. That happened to be a private hospital’s A&E.
On arrival, they asked me whether I had private medical insurance and checked me in.
I was seen fairly quickly by a foreign doctor who asked for blood tests and a chest X-ray. While the chest appeared to be clear, the blood results were a cause for concern, and due to the deviation from the norm, of several readings, the doctor affirmed he had no option but to refer me to a specialist Covid ward in one of the region’s public hospitals.
I was surprised by this decision, for two reasons:
- It seemed to me that the private hospital was limiting its level of responsibility, and passing the risk back to the state, generating income at the “easy” front end and then referring the patient to the state system for the more complex (and correspondingly potentially expensive) stage of diagnosis and treatment
- The Portuguese state was creating this pressure for itself: it was forcing patients to seek private medical advice due to lack of capacity, but then accepting patients back into the system with a likely higher cost of treatment. If one were a little more cynical, it could be interpreted as a way of making a saving by forcing the outsourcing of part of the process, thereby eliminating associated costs for that part of the medical process
Administratively, the private system worked well, even at night. The receptionist kindly asked if I had a loyalty card for a large national retail group, and with that I received a 25% discount on the total cost of around €150.
They provided me with copies of my blood results as well as a CD with my X-rays. I was also given a referral letter for the hospital A&E and recommend to attend Portimão which apparently had a better reputation than Faro.
The public hospital
I arrived at A&E at the public hospital in Portimão at around midnight and after checking in, was asked to wait in a covered, outside area reserved for anyone diagnosed with Covid or suspected of having it. A few minutes later, I was led to a special “isolation” ward set up in a set of containers. Each patient had an individual, disinfected room with a chair and a toilet, where communication with staff was via a glass panel.
I showed my blood results, and was asked to take a chest X-ray, which I refused, because I had a CD version of the X-ray I had just taken. The male nurse on duty was quite dismissive, saying that radiologists liked to take their own X-rays and the hospital system was unlikely to be able to read the CD. I insisted, and what was the nurse’s surprise when the radiographer agreed with me and downloaded the images onto the system. In addition to looking foolish, it was disappointing to note that the nurse showed no interest in reducing possible costs. My immediate thought was to the thousands of times when unnecessary expenditure had been incurred due to laziness or lack of flexibility.
My hospital visit lasted approximately two hours, and fortunately the doctor, again foreign, felt that I could recover at home. I was discharged with a prescription for antibiotic and a few other things.
Reimbursement of expenses
I was covered by insurance which reimbursed all my private hospital bills and the medicines, less a deductible, in 3 days after my claim. The only real cost was therefore the insurance policy deductible.
Conclusion: managing the interface between public and private healthcare in Portugal
As I have always known, when any health situation is grave, the solution lies with the public health system. Despite its shortcomings, it is still the place to which most of the population turn.
The public system is also slow, and so when something is urgent, primary care such as the health centres or centros de saúde, that feed into the hospital system, are often unable to react in time. It is here that the private system can play an interesting role: in accelerating access to diagnostics and first opinion. Should it be needed? In a country such as Portugal, where the national health system is a universal franchise, no. But the reality is that with doctor shortages, low pay, bureaucratic system and much more, it is worth considering a private (and relatively inexpensive) health plan that can help when the public system is unable to respond quickly enough.