This figure is more than double the average for the Organisation for Economic Co-operation and Development (OECD).

The data is contained in a study on access to the emergency services of the National Health Service (SNS), released by the Health Regulatory Authority (ERS), which concluded that between 2022 and the first half of 2024, there were 15,952,048 admissions, a use that remained “relatively stable” over the five semesters analysed.

“When considering the ratio of emergency episodes per 100 inhabitants, the figures observed in mainland Portugal are well above the OECD average,” an organisation made up of 38 member countries, the regulator points out.

In 2023, Portugal had a ratio of 64 per 100 inhabitants, while in the OECD the figure was 26.6, according to ERS data, which places the Alentejo and Algarve regions with ratios higher than the national average.

The study also states that, in 2022, 71.8% of admissions were on the patient’s own initiative (self-referral), falling to 69.9% in 2023 and 64.4% in the first half of 2024, while there was an increase in the proportion of episodes referred by the SNS 24 Line, which reached 11.4% in 2024, compared to 6.5% in previous semesters.

“This evolution may be associated with the implementation of the `Call First, Save Lives” programme, which established prior referral as the rule for admission to the emergency room,” says the ERS.

How urgent were the cases?

Almost half of the self-referred episodes (49.9%) corresponded to the clinical priority of “not urgent” or “not urgent”, a figure close to that recorded for referrals via the SNS 24 Line (46.2%).

The analysis of triage in the emergency services revealed that the majority of admissions corresponded to episodes classified as “urgent” (44.7% in 2022 and 46.4% in 2023) and “not very urgent” (40.8% in 2022 and 38.6% in 2023), which together accounted for around 85% of the total. Emerging” and “very urgent" situations remained stable at around 11%.

Compliance rates with the target times for care (Manchester triage) were systematically lower for the most serious priorities, reaching 44.4% for “very urgent” and 66.5% for “urgent” in 2023.

The regulator also identified a high hospitalisation rate in episodes triaged with the colour white, which rose to 18.1% in multipurpose emergency services, which “seems to show that the emergency service was often used as a means of hospital admission, to the detriment of its care function”.

New admission bracelet

In Portugal, a white bracelet has been implemented, which does not constitute a clinical priority, and which only aims to identify and monitor situations of inappropriate use of emergency services.

According to the study, in 2024, 95.4% of the population of mainland Portugal lived within 60 minutes of an emergency room with general and paediatric care, while in the case of obstetric and gynaecological emergencies, population coverage by the network points reached 93.9%.

Amounts wrongly charged

The regulator also notes that in 2022, 16,995 emergency cases referred by the SNS 24 Line were unduly charged user charges, a figure that fell to 11,912 in 2023.

From January to June 2024, 9,823 emergency appointments were unduly charged, a higher total than in the first six months of 2022 and 2023.

Complaints from users

In the period under review, the ERS received 56,013 complaints about emergency services, mainly focused on waiting times, patient care and safety and the humanisation of the services provided.

At the end of June 2024, the SNS had a network of 89 emergency services, with various levels of differentiation - basic, medical-surgical and multipurpose.