Portugal's Parliament has given initial approval to rules that would make non-resident foreigners pay for treatment in the state health service — or prove they're covered by insurance — a change that matters for tourists, snowbirds and second-home owners who fall ill while in the country.
The bill, put forward by the PSD and CDS-PP, targets people who aren't legal residents or are staying irregularly. Under it, they'd either settle the bill for care received through the SNS (Portugal's National Health Service) or show proof of insurance or another party responsible for the cost. There's also a mechanism to secure payment up front — a deposit or guarantee — in cases where authorities think it's needed. Emergency treatment is carved out: anyone needing urgent care gets treated first, with the paperwork sorted afterwards. A separate Chega proposal, also approved, would apply payment requirements specifically to non-EU citizens, asylum seekers awaiting decisions and migrants without regular status, again with emergencies exempt. A tougher Chega bill demanding full payment at discharge and extending co-payments to some pregnant women failed, however.
What pushed this onto the agenda? Unpaid bills in the Algarve, Portugal's tourism heartland. An audit by the health inspectorate IGAS found more than €1.2 million in invoices for emergency treatment given to non-resident foreigners in 2023 and 2024 went unpaid. Over the same two years, non-resident foreign patients in Algarve emergency departments rose 7.8%, from 17,736 to 19,111. PSD Algarve politicians argued the figures showed the issue isn't abstract in a region that welcomes millions of visitors a year.
Not everyone agrees stricter access is the answer. The centre-left PS, which voted against along with several other parties, says existing law already makes non-residents liable for payment — the real problem is that the money is never actually collected. A non-binding resolution it passed asks the government to quantify how many non-residents use the SNS, what it costs, and to report back on debt-collection procedures within 90 days. Meanwhile an Iniciativa Liberal recommendation, which passed, goes the other way: collect payment before treatment, or take a deposit.
The legislation now heads to committee for detailed work before a final vote, so nothing changes immediately. But the direction of travel is clear: Portugal's state hospitals are becoming less of a free backstop for visitors.
For travellers, the practical takeaway is straightforward. If you're heading to Portugal — particularly the Algarve in summer, when emergency departments handle a heavy load of tourist cases — sort out travel insurance before you go and carry proof of it. EU citizens should bring a European Health Insurance Card, which covers necessary state care at home-country rates. Non-EU visitors have no such safety net, and if these rules pass, they may increasingly be asked to demonstrate how treatment will be paid for. Emergency care will still be provided regardless, but the billing follow-up could get much more rigorous.
