Privately managed health centres, officially termed Family Health Units (USF), planned for Silves and Lagos could begin operating as soon as the second half of this year, the health minister announced today.
In the Algarve region, four applications were submitted, three of which have already been selected and concern model C centres to be created in Silves and Lagos.
“The evaluation will be concluded this week and, if the process is finalised without obstacles, these units should likewise begin operating in the second half of the year,” the minister said, adding that this type of health unit “is generating interest” and that “there are teams willing to take on this challenge”.
In January, the Central Administration of the Health System (ACSS) estimated that more than 250,000 patients would be covered by the new privately managed health centres (USF-C) set to open in regions with the lowest availability of family doctors.
In addition to the two USF-C units planned for Silves and Lagos, the Algarve;s health board (ULS), intends to launch another tender for a privately managed family health unit serving the municipalities of Albufeira, Loulé and Portimão.
At the time, the central ACSS entity expected the remaining tenders to be launched by the end of February, covering the Amadora/Sintra, Lisbon Western, Loures-Odivelas, Santa Maria, São José and Tagus Estuary health units.
With the aim of reducing the number of people without a family doctor, the government approved a decree-law in September 2024 allowing health centres to be run by private and social sector providers as well as local authorities.
The health emergency and transformation plan foresaw that in July 2024 the first 20 USF-C contracts would be tendered: 10 in Lisbon and the Tagus Valley, the region with the country’s greatest shortage of family doctors, five in Leiria, and five in the Algarve.
In December, the finance and health ministries authorised the Algarve, Amadora-Sintra, Tagus Estuary, Lisbon Western, Oeste, Leiria, São José and Santa Maria health units to meet the costs of creating these new centres, amounting to roughly €70 million through to 2030.
However, just last year the Association of Family Health Units called for clarification over the new USF-C centres. “If we start diverting public money to the private sector for areas that were previously guaranteed solely by the public service, that will clearly create problems in the future,” said André Biscaia, president of the National Association of Family Health Units (USF-AN). He argued the funds should instead be used to “safeguard what is already being provided today by the social and private sectors”.
Rather than creating USF C units or other public-private partnerships (PPPs), he said the state could simply pay more for certain diagnostic tests already performed privately but for which patients struggle to find contracted clinics, such as ultrasound scans.
“I work in an area near Lisbon and have difficulty arranging an abdominal ultrasound, a gynaecological ultrasound, an obstetric ultrasound. A soft-tissue scan is almost impossible,” he said, adding that authorities should “use that money to better remunerate these contracted examinations”.
That approach, he argued, would strengthen key areas in which the profit-oriented private sector already plays a significant role.
Biscaia also pointed to rehabilitation services: “Physiotherapy treatments also need better payment, because at current rates it is difficult to achieve real effectiveness.”
As for the social sector, he suggested it could take responsibility for residential care homes for the elderly “instead of that burden falling on family health units or primary care”.
“There are many thousands of people and it could be an area for the social sector, which already has strong implementation there,” he added.
He insisted the concept of USF C must be “much clearer”, warning the units must comply with the same legal requirements as other family health units.
“It is necessary to clarify what the model C USFs being proposed actually are and whether they meet the legal requirements to be USFs. Otherwise it is simply an abusive use of the name. If they are doctors’ cooperatives or private entities, they are not USFs, they are something else entirely,” he said.
Asked about the experimental phase of 20 USF C units announced by the government, health economist Julian Perlman of the National School of Public Health warned that limited competition in Portugal could make them costly to run.
He noted the private sector “is dominated by three or four groups”, adding: “My concern is that it may end up being very expensive for the state, which, using taxpayers’ money, instead of paying for care ends up paying for the profits of large groups.”
Perlman, who has studied reforms converting primary care units into family health units to improve efficiency and outcomes, also raised staffing concerns. To attract doctors from the private sector, salaries would have to rise, potentially making USF C more appealing than existing units.
“My guess is we will recreate a two-tier system: USF C units with very well-paid doctors, better working conditions and tighter regulation, and traditional USFs with worse conditions and doctors still wanting to leave,” he concluded.
He criticised such duality, noting inequalities in access linked to where patients lived had previously been addressed by converting all units into USF B , and questioning whether the reform would now reintroduce unequal access.
According to the National Health Service transparency portal, by December 2025 more than 10.7 million people were registered in primary healthcare, a figure that has risen steadily since March 2024, while 1,563,710 patients had no allocated family doctor.
Source: DN / LUSA
