What free public healthcare is like in Portugal

Photo by Martha Dominguez de Gouveia on Unsplash

Back in 2014, my daughter was sick. She was just about a year old, and I don’t remember the exact circumstances that prompted the trip to the ER, but I do know there was a high fever, and she couldn’t stop vomiting.

I remember the 7-minute drive to the ER from our home in Eagle, Idaho, and having to clean her up in the dark hospital parking lot because she couldn’t even make it that long without getting sick. Arriving, filling out forms, handing over hers and my insurance cards. Being taken to triage, then to the treatment room where a woman took our information, standing in front of a mobile computer stand.

But what I remember most from that visit, aside from the gripping fear of a new mom with a sick baby, was the moment the woman said:

“So we ran your insurance, and your copay is $600. Can you pay that now?”

I blinked, cradling my ill baby, who had just stopped crying and was cuddled in my arms, sick and exhausted. I was exhausted too. “What?”

“It’s $600 for your visit today. Can you pay that now?”

I ran quick mental calculations. Could we cover that? I didn’t know for sure, but I was embarrassed to admit that to the woman standing there, staring at me. I knew $600 was just the start of the bills I would receive from the hospital because I hadn’t met my deductible that year. We were fortunate at the time, because I was still in graduate school, so at least our premiums weren’t as expensive as they would be a few years later when I graduated. Still, the amount we did pay in premiums was a lot for us.

I looked to my purse on the chair next to the hospital bed, where I was sitting and holding my daughter. Would they refuse us if I couldn’t pay now? I wasn’t sure, but I didn’t want to find out. I just wanted them to take care of my baby.

“Uh, yeah. Yeah, OK, ” I finally said. I stood, baby in arms, and awkwardly grabbed my purse, took out my debit card, and handed it to the woman. I bit my lip, thinking about the balance and if we’d be OK that month. But then I looked at my baby and realized it didn’t matter. Her care came above all else.

“Here you go,” the woman said, handing me back the card and a receipt, which I stuffed into my purse. “Get better,” she said to my daughter, then turned her attention to me. “Hang in there.”

Hours later, we were leaving. I don’t remember the diagnosis, but I do remember she was given some anti-nausea medicine and a prescription to pick more up at the pharmacy the next day. It was late when I left, and I was still just as worried. But I was even more broke.

In 2014, my adjusted gross income for the year was $44,704. Of that, we paid $8,316 in taxes and $1,869 for health insurance.

We were living on $34,519 a year, or $2,876 a month. We were paying on our undergraduate loans. Our rent was $1,100 a month, which was a deal for the area we lived in. I was paying out-of-state tuition for my graduate credits because I had given up my stipend to take a work opportunity in Idaho (before I found out I was pregnant—I’m sure I would have made a different decision had I known).

I had just paid nearly 21% of our monthly budget for my baby’s care. And we still had to eat and pay our bills.

This week, about seven-and-a-half years later, I got a call from my husband that our son hurt his hand at school. He’d tripped while helping clear the lunch dishes and had a deep cut in his right hand, which was bleeding a lot. We needed to take him to the ER. I called my friend, who has lived here in Portugal for several years, and asked her advice. We’d had challenges navigating the private hospitals here because the one near us doesn’t staff pediatricians, and in the past, we’d driven nearly an hour to the private hospital to see a pediatrician in the ER. My friend suggested the public hospital.

I had never been to a public hospital before for care, and to be honest, my view of them hasn’t always been rosy. Growing up in the US, I was fed propaganda about government-run healthcare. But just this past week, I listened to an eye-opening episode of Planet Money (such a good podcast!), in which they detailed a PR campaign by healthcare companies to disparage Canadian healthcare. The episode made me pause and consider whether my perception of public health was accurate.

Plus, the public hospital was the closest option, and my son was in pain and bleeding, so we decided to try it.

Now, before I go on, I want you to understand my frame of reference for this experience. I have been to hospitals in the Dominican Republic, Vietnam, Thailand, and Portugal. And, of course, the United States. I once visited a friend at a hospital in a developing country where there was blood smeared on the wall behind him, and they didn’t have medicine at the hospital but his partner instead had to walk across the street to the pharmacy to get the medicine he needed, then bring it back to the hospital. I’ve been to private hospitals with grand lobbies and fancy facilities in Thailand and Vietnam, and waited in line with dozens of people at a hospital in the Dominican Republic to receive an ankle x-ray and get bandaged too tightly with my ankle angled painfully in the wrong direction. (My dad later helped me over Skype, talking me through the steps as I rewrapped my painful, black and purple, swollen ankle).

So this is all to say, I’ve seen a lot of hospitals in a lot of countries, both before kids and after becoming a parent.

Driving up to the public hospital in Portugal’s algarve, I was struck first by the size (all the ones we had been to here were much smaller) and the external grittiness. Something about the weather in Portugal dirties the buildings much faster than other locales, and this place was no exception. But then we pulled onto the grounds, and I realized this place looked just like the hospitals back home. The grounds were well-organized, with clear signs and ample parking, and a security guard who pointed us to the pediatric ER.

Wow, I thought, we can drive right up! The private hospitals we’d been to in Portugal didn’t have that option.

My husband dropped me and my son at the entrance, and, because of COVID, we waited outside while a nurse came to triage us. She was sweet and gentle with my son as he refused to show her his bandaged hand. I explained what happened and she told us to wait a few minutes. About three minutes later, we were let inside. To check in, I simply handed over my son’s resident card. We haven’t registered for public health, but no matter. When I told the man at the front our son’s school had insurance, he said OK and asked for the name of the school.

“I’ll give you papers to give to them,” he said. No more questions. We were told to wait and someone would be with us soon.

A couple minutes later, a nurse brought us back to a treatment room. They removed his bandages and cleaned the wound with a yellow-colored antiseptic that stained his skin. When he cried, the nurse was gentle. She talked to him, calming him. Her English was good, and she had a nurturing quality I have come to love about Portuguese culture. I turned on Thomas & Friends on my iPhone to distract him from the pain, and looked closely at the wound for the first time. It was deep and bleeding a lot. Poor buddy. It must really hurt.

Minutes later, the doctor came in. He was less communicative and got right to business checking my son’s hand as I introduced myself and asked his name. I’ll admit this had me initially questioning the care: Did he speak English? Was he going to talk to us at all?

When my son cried in pain and pulled his hand away, the doctor softened and began talking gently to my son to calm him down. He explained the treatment plan to me (glue and bandage for 10 days, no stitches) and set to work bandaging carefully, offering encouragement to my son along the way. When he was done, we went to his office, which he shared with another doctor. Because of HIPAA in the US, I have never been in a doctor’s office while another patient was talking with another doctor on the other side of the room. We were given a note to bring to our local health center to have his hand checked at a later time. I got the papers from the front desk, with a total bill of €85 to give to the school so they could submit it to their insurance. It would have been free if I had registered with the public health system.

We were in and out in less than 30 minutes. No one asked me to pay a dime.

The hospital wasn’t as nice or new as the hospitals back home. But the rooms were tidy and clean, and the care was good. Back home, we expected an ER visit to take at least three to four hours, and cost at least $1,800 each time.

The difference today is that I can afford that ER bill. I make multiples of what I made back in 2014. And while I will probably choose to go to the private hospitals in the future—what a privilege to have a choice!—if we need emergency care, I’m really glad to have a public health option that takes good care of our family.

I still remember what it was like to be a new parent, just trying to get by on a tiny salary. I remember feeling gripped by fear about my daughters health, and trying to swim through the emotions to logically calculate our ability to pay. It was a horrible moment, and defeating, and I remember feeling guilty even thinking about money when my daughter was so sick. And I hope I never forget that moment, because it taught me so much about the choices many parents have to make in the US and beyond.

Have you ever been in a situation like the one I was in, back in 2014? What has your experience with healthcare been, either abroad or at home? Share with me in the comments—I love to hear from you.

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