a deficit of 1.23 million euros due to unpaid invoices

When it comes to summer season on the Algarve side, those magnificent beaches, turquoise sea and crowded seaside towns always come to mind. But there is also the other side of the coin: In this region, which hosts millions of tourists every year, the health system is put to a serious test every summer. The latest official reports also clearly revealed the financial dimension of the situation. According to the latest audit report published by the Portuguese Health Activities Supervision Agency (IGAS), the Algarve Local Health Unit (ULS Algarve) failed to collect more than 1.23 million euros for the emergency healthcare services it provided to foreigners who do not live in Portugal in the last two years (2023 and 2024). In other words, there is a huge deficit that does not go into the hospitals' coffers. Invoice is issued but collection is a lie Here's the thing: Under Portuguese law, everyone has the right to emergency healthcare, regardless of their nationality or legal status. Hospitals do not turn away anyone who enters the door, they treat them. As a matter of fact, the total value of the services provided to foreign tourists in emergency services in the Algarve in 2023 and 2024 amounted to approximately 2.35 million euros. However, more than half of these invoices—€1,234,358 to be exact—remain on the books as unpaid receivables. When we look at the statistics, there is a significant increase in the number of non-resident foreigners applying to emergency services: 2023: 17,736 applications 2024: 19,111 applications (An increase of approximately 7.8%) As expected, these applications peak during the summer months. Almost 70% of hospital admissions are working-age adults aged 18-65. The leading countries are not surprising: England, France, Germany and Ireland. Where is the System Clogged? So, why can't this much money be collected? The report clearly outlines the bottlenecks in admissions processes and bureaucracy: Language Barrier and Missing Documents: It is not always easy to communicate with tourists who come to the hospital. Most of the time, insurance documents or identification information are missing. Avoiding Giving Address: Some patients are reluctant to give their contact information in their home country or the hotel/rental house address where they stay, and sometimes even refuse. Lack of Entry-Exit Control: Under normal circumstances, the same admission procedure is applied as other patients, but when the treatment is completed and the discharge phase is reached, there is no effective mechanism to prevent the patient from leaving without paying. What Steps Are Recommended for the Solution? IGAS auditors made very clear recommendations to hospital management in the Algarve to close this hole. First of all, foreigners who do not have a valid private insurance or a third institution that assumes responsibility are asked to evaluate whether the fee can be collected at the moment of entering the emergency room, rather than at the end of the treatment. It also aims to tighten patients' identity verification processes and introduce a mandatory "exit point" check when leaving the hospital, which will make it impossible to avoid payment. Tourism brings serious income to the region, this is a fact. However, it does not seem sustainable for the local health infrastructure to shoulder the burden of millions of euros alone every summer. Let's hope that these new measures will come into effect quickly and the financial burden on hospitals will be eased a little. Source: LUSA Photo: Duarte Drago / LUSA