On Sept 15, Portugal celebrated the 40th anniversary of its national health system. Since its creation, there has been impressive progress in Portugal's health indicators. Infant mortality per 1000 livebirths decreased from 3·3 in 2006 to 2·9 in 2017, and life expectancy of men and women increased by more than 4 years over the same period to 81·3 years (longer than the EU average). However, the tide is changing and after the economic crisis, cuts in public expenditure have introduced new challenges. According to WHO , Portugal is one of only four countries (of 33 analysed) that reduced public health expenditure between 2000 and 2017.

As this falling investment is preventing the modernisation of hospitals and replacement of obsolete medical equipment, private care is expanding. The public medical workforce, discouraged by poor work conditions, are seeking jobs in the private sector and overseas. Dental consultations and diagnostic tests are most commonly provided by the private sector and are triggering an increase in patient out-of-pocket expenses, which are already 28% of total health expenditures, substantially higher than the EU average (15%), according to the Organisation for Economic Co-operation and Development. Other elective treatments are becoming restricted to the population who can afford private care. Politicians face challenges at both ends of the age spectrum: child poverty rates are above the EU average, and the ageing population, one of the oldest in Europe, is unhealthy with a poor quality of life in later years.

On Oct 6, Partido Socialista, a centre-left-wing political party, won the general election, despite failing to secure a majority. In his manifesto, António Costa, the party's leader, established four major challenges to be addressed by the next government: climate change, demography, the transition to a digital society, and inequality. At a time when the national health-care system no longer meets the needs of a substantial part of the population, the re-elected government must take this new opportunity to prioritise health and make health care accessible for all.

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