The conclusion forms part of the analysis by the Health Expenditure Observatory 'Private health insurance in the Portuguese health system: myths and facts', prepared by researchers Pedro Pita Barros and Eduardo Costa, within the scope of the Social Equity Initiative, a partnership between 'la Caixa' Foundation, BPI and Nova SBE.

"More than just analysing the evolution of the number of private health contracts in Portugal, it is necessary to understand the reasons for this growth and its role in the Portuguese health system", says the Health Expenditure Observatory.

According to the observatory, the progressive increase in the volume of voluntary private insurance subscribed by the population - which rose from 14% in 2000 to 32% in 2021 - does not necessarily translate into an equivalent increase in the importance of health insurance in financing expenditure in health.

"The funds moved by private health insurance represent (in 2020) only 4% of the total expenditure on health care, which contrasts very clearly with the number of private health insurance contracts. That is, although there are many contracts, these on average cover very little quantitatively and, consequently, direct payments from families, which in the last 10 years have not suffered any significant reduction, remain at very high levels", he stresses.

For economists, the opportunity left open by this lack of financial coverage of many health care expenses is not taken advantage of by companies that provide private health insurance, arguing that "they could expand their activity by occupying the space of complementarity to the SNS and consequently reducing the effort of families in the moment of need and use of health care".

The analysed data also concludes that there is "a strong negative correlation" between the role of private health insurance and that of private subsystems.