Sustainability of the NHS will depend on the ability to implement structural reforms, according to the La Caixa Foundation

The 2026 State Budget foresees consolidated effective expenditure of €17.236 billion for healthcare, reflecting nominal growth of 2.7% compared to the budgeted amount for 2025. This is one of the main pieces of evidence revealed in the most recent information note from the Health Expenditure Observatory entitled "State Budget for Healthcare: Ambition or Fiction?", which was written by researchers Carolina Santos and Pedro Pita Barros, holder of the BPI/la Caixa Foundation Chair in Health Economics, as part of the Social Equity Initiative, a partnership between the la Caixa Foundation, BPI and Nova SBE.

The analysis emphasizes, however, that the sustainability of public finances in the health sector continues to face significant challenges. Although the government projects a positive budget balance of €907.3 million, this projection relies heavily on revenue from the Organic Health Mission, the origin and reliability of which are not adequately specified in the budget report.

Regarding transfers to the National Health Service (SNS), these amount to 14,935.8 million euros, which represents an increase of 7.1%, signaling a strengthening of the SNS's role in the health system, according to the study.

"The budgetary priorities outlined by the Government are in line with the structuring principles of the public health system, with an emphasis on improving access to health care – from screenings to primary and long-term care," according to the Observatory.

"In line with its political orientation, the Executive strengthens its commitment to collaboration with the private sector, including for-profit and non-profit entities, to expand the NHS's response capacity in the short term. However, this model of public financing with private provision raises critical questions that require clarification, especially regarding continuity of care, the creation of integrated public networks, such as in oral health, and the preservation of the NHS's public mission," argue researchers Carolina Santos and Pedro Pita Barros.

Despite increased investment in human resources, the average productivity of the NHS fell by approximately 25% between 2015 and 2024. According to the analysis, this decline may be due, in part, to the greater complexity of the cases handled. However, it appears that the drop in productivity is associated with structural problems, such as the increased reliance on service provision and supplementary pay; growing reliance on overtime; and the lack of effective accountability and performance management mechanisms.

"The new program budget structure introduces positive changes, but requires methodological adjustments and greater clarity in the presentation of data to ensure a coherent reading of the sector's expenditure and revenue," argue the researchers.

"The efficiency requirements for 2026 are high, especially after the strong expenditure growth of recent years. However, the usual recourse to late payments settled with additional funds remains stipulated in the budget law, which could reduce the incentive to contain costs and adopt structural efficiency measures," they add.

The sustainability of the NHS will therefore depend, in the coming years, on its ability to implement structural reforms, ensure the transparency of budgetary forecasts and preserve the principles of universality, equity and solidarity that underpin the public health system in Portugal, the study concludes.