User:LaetitiaXYZ/Access to healthcare for migrants in Portugal

Healthcare is universal in Portugal. The public service, the National Healthcare Service ("Serviço Nacional de Saúde", or SNS), is accessible to all people, albeit with different billing conditions.

Universality of access to healthcare
The Constitution of the Portuguese Republic states, on its section 64, paragraph 3, item a), that "in order to ensure the right to health protection, it is primarily the responsibility of the State to ensure that all citizens, irrespective of their economic condition, have access to preventive, curative and rehabilitative care".

Portugal's Basic Health Law (Law 48/90) states on its Base II, paragraph 1, item b), that "it is a fundamental objective to achieve equality of citizens in access to health care, irrespective of their economic condition and wherever they live".

Law 93/2017 – that establishes the legal system for the prevention, prohibition and combating of discrimination on the basis of racial and ethnic origin, color, nationality, ancestry and territory of origin – states that discriminatory actions include "the refusal or limitation of access to health care provided in public or private health facilities" (section 4, paragraph 2, item e)).

Access to public healthcare services cannot, thus, be denied, and especially not by clerks and administrative personnel – even to people who decline to pay expenses bills –, for they aren't neither trained nor mandated to perform triage.

Payments
Pre-payment of expenses or symbolic fees (depending on which applies to a given person and/or situation) may and should be tried by such public servants. Not being able (or willing) to pay up front cannot be used as motive to deny access to services. Payments may be made at a later time and agreements to paying by installments is possible. Not paying (or asking for correction of the expense bill) in due time may lead to charging of late payment interest.

The are two payment modalities: (...)

Handbook for the public healthcare services
In January 2014 a Handbook for Reception in Access to the Health System of Foreign Citizens came into force as work instrument.

This Handbook has some minor errors but nothing that may hinder proper reception of foreign people in public healthcare services.

Access to healthcare flowchart
There are two main top level categories:

a) foreign citizens with (documented) permanent residency in Portugal, and

b) foreign citizens temporarily staying or residing in Portugal.

People in the first situation may be split in, again, two groups:

i) nationals of member-states of the European Union, European Economic Area, or Switzerland, and

ii) nationals of other countries that are not covered by bilateral agreements.

(...)

Despacho n.º 25360/2001 came to institute that, to all foreign citizens residing legally in Portugal, access be be granted in equality of treatment given to beneficiaries of the SNS concernig health care and medication assistance provided by the institutions and services that comprise the SNS. In practice this led to issuance of beneficiary numbers ("número de utente") to holders of residence permits.

It also states that people in irregular situation of stay that have been residing for more than 90 days in Portugal (proved by means of a residence certificate issued by a Junta de Freguesia).

Getting a residence certificate from Junta de Freguesia
Often Juntas de Freguesia issue certificates that don't declare the person has been living in the the country for more than 90 days; when this happens health services still accept the document and check the arrival date stamped on the passport to check if more that 90 days have passed. Also often Juntas de Freguesia demand two witnesses (voters registered in that freguesia) to declare the veracity of the information; this is illegal but customary, and probably derives of ill interpretation of the change in the law regulating the local government.

In May 2015 Decree-Law 73/2014 changed the wording of Decree-Law 135/99 from "the certificates of residence, life and economical situation of citizens, as well as terms of identity and administrative justification, issued by juntas de freguesia (...) must be issued as long as any of the members of its respective executive or of the assembleia de freguesia has direct knowledge of the facts to certify, or when the proof of such facts be made by oral or written testimony of two voting citizens registered in the freguesia, or, yet, through declaration by self" to "the certificates (...) must be issued as long as any of the members of its respective executive or of the assembleia de freguesia has direct knowledge of the facts to certify, or when the proof of such facts be made by oral or written testimony of two voting citizens registered in the freguesia, or by other legally admissible mean".

Recomendation 1/A/2013 from the Justice Ombudsman states the administr