LISBON — For Francisco Reposo, the 30% pay cut he was forced to take this year amid government austerity measures is the least of his worries. The high school science teacher is also on dialysis, awaiting a kidney operation, and Portugal’s financial bailout means he’s saddled with hundreds of dollars in monthly medical bills.

The cost of seeing a doctor in Portugal has more than doubled, from about $12 to $26 a visit. Reposo used to pay nothing for dialysis because he’s a blood donor, but that exemption was lifted, and he now pays about $53 for each session. Last month, he went three times.

“It’s had a serious impact on my financial situation,” said Reposo, 51. “But I need to go to the hospital, because otherwise it’s horrible pain.”

Those fees may seem low by U.S. standards. But the Portuguese, like most Europeans, have long been accustomed to universal public healthcare, one of the government benefits at the core of Europe’s postwar welfare state. Now such entitlements are slowly being chipped away by the continent’s debt crisis.


At least half a dozen European countries have either increased health fees in recent years or are considering it as a way to cut costs. Spain, Portugal’s neighbor on the Iberian peninsula, is in the process of implementing a slightly less punishing version of Lisbon’s new fee scheme in hopes of staving off the need for a bailout.

The cutbacks may be having a particularly grim effect here in Portugal, already Western Europe’s poorest country. The nation’s mortality rate shot up this winter: Nearly 20% more people died in February and March than in those months last year.

The government blames a nasty flu strain to which the elderly are most vulnerable, especially this winter, which was colder than average. But independent organizations and some opposition politicians say it’s evidence that austerity not only imperils people’s livelihoods, but may also endanger their lives.

In light of Portugal’s bailout last year by the European Union and the International Monetary Fund, which totaled more than $100 billion, Lisbon says the fee increases are necessary to come in line with EU spending rules and slowly dig itself out of debt. Hospitalization now costs $26 per day, and as much as $67 if additional services such as a CT scan or X-ray is needed.


Yet while those fees go up, incomes in Portugal are forecast to fall 3.25% this year, in a country where the average salary is just $16,400 a year. The country’s jobless rate is more than 14% and rising. And there is fear that the government may have to ask for a second bailout.

Reposo says that the number of fellow chronic kidney-disease patients he used run into at the hospital has dwindled.

“A lot of people had to stop taking their pills,” he said. “Many people avoid going to the hospital, because they have no money to pay the fees.”

The government estimates that one-third of the country’s public hospitals are insolvent. The breakdown in care disproportionately endangers the elderly, many of whom “live in misery and poverty,” said Ana Filgueiras, who runs a local charity called Cidadaos do Mundo, or Citizens of the World.


“I spoke with many people who were ill before these changes, and sometimes they would not go to the doctor because they could not pay for transport or because they could not walk,” Filgueiras said. “So if you think about that, and now the fact that they need to pay [so much more] — it’s an extra burden.”

Filgueiras offers the example of her own mother, anAlzheimer’spatient who survives on a typical government pension of about 300 euros a month, just shy of $400. She’s on medication that’s available at a discount only with a neurologist’s signature, but the nearest specialist is a two-hour bus ride away. Filgueiras often intervenes to pay for the medicine at full price rather than risk her mother getting lost, confused or injured on the commute.

“Without a signature, the medicine costs 160 euros per pack, and she uses two packs per month,” Filgueiras said. “So can you imagine?”

Portugal already has Europe’s highest rate of diabetes, and the third-highest in the developed world, behind the United States and Mexico, according to the Organization for Economic Cooperation and Development. A recent study by the Portuguese Society of Cardiology estimates that 1 in 4 Portuguese runs a high risk of dying of a heart attack or stroke in the next 10 years, but only 30% of those at risk take adequate medication.


Now a sick economy may be exacerbating that.

“It’s true we had user charges dating back to the ‘90s, but they were relatively low,” said Pedro Pita Barros, a health economist at Lisbon’s Nova School of Business and Economics. “The level has doubled here now, and that was not expected.”

In addition to higher charges, free transportation for most seniors was scrapped. And some special concessions were eliminated, such as blood donor Reposo’s exemption from fees.

Reposo is on a waiting list for surgery, and his dialysis appointments will increase in frequency the longer he waits.


“I’m able to go, because I still have my salary, even if it’s smaller now,” said Reposo, who turned up at a recent anti-austerity protest in Lisbon to vent his frustration. “But I don’t know. One day, if I have no money, will I decide not to go?”

Frayer is a special correspondent.