Nationalize Heath Care

Snacks, reading material, ipod, journal.  Check.  Passport, documents, segurança social info, Check.  It was as if I was actually going on an international trip or something. My backpack’s contents could have served for an oversees voyage.  Given, I didn’t have any extra clothes with me, but I did have my umbrella, should the dark, threatening clouds give way again and unfold blankets of wetness upon me. 

The centro da saude wasn’t all that far.  Up a few hills, turning a few corners, and at the end of a dead end street. I should be able to find it.  Saturdays are sometimes just as complicated as Sundays. Everything shuts down, including the pharmacy. I was in need of meds, prescription meds that is, and so the only way to get them was to go to the health center and hope that the on-duty doctor would issue me a prescription.

I had heard stories about the emergency rooms in Portugal.  Full and chaotic, overcrowded and nightmarish.  Minor problems turned into traumas on weekends, when everything else was shut down and you are forced to go the emergency rooms.  With that in mind, I had prepared my backpack accordingly.  I really had no idea what to expect.  Especially because I wasn’t officially enrolled in my neighborhood health center.  In fact, I had never been there and didn’t really know what I was getting into.

These are the banal tasks of daily life that suddenly turn into odysseys when you are living outside of your own country, subject to the misunderstandings and ambiguity of foreign systems, to the whims of the bureaucratic populace that, without fail, give you varying answers to the same question.

And so, after experience you slowly release the control, the need for black and white answers, and you surrender yourself to the powers that be, wherever and wherever they might be in each individual situation in which you find yourself. 

Walking into the health clinic, backpack secured on my person, I find a surprisingly empty lobby.  Prepped with passport, national ID card, health system number, and proof of address, I pass over my documentation to the only person there.  She punches in my information to her computer and issues a bill for 2,15€.  That was the charge for my visit that day.  No questions, no dramas, no circular answers.  Before I could put my papers back in my bag her assistant was calling me back into the consultation room.  Could this really be so smooth?

Back in the office I met with a pleasant female doctor who was sitting behind a small desk in a stark white room.  Earlier on when packing my bag, I had decided against bringing my Portuguese-English dictionary and simply made sure I knew how to explain my symptoms.

After a painless and quick 5-minute conversation, she issued me a prescription for antibiotics.  There was no lab work to be done as it was Saturday so she confidently trusted my self-analysis and gave me the slip and it was a done deal!

Proudly striding out of the clinic I felt a sense of accomplishment.  After all, I had procrastinated all afternoon in the house, not keen on making the visit to the center and fearing a ridiculous wait time and bureaucracy.  Quite the contrary.  I was amazed at how easy it was- but reminded myself not to discount all of the other horror stories I had heard from Portuguese friends who deal with the health system on a more regular basis.

Now, given almost all pharmacies are closed on Saturdays and Sundays, my next task was to find the nearest appointed weekend pharmacy.  Every few neighborhoods there is one pharmacy scheduled to stay open during the weekend so you aren’t left completely stranded.  How kind of them.  Luckily, it just so happened that this weekend the open pharmacy was in the same neighborhood as the clinic.  I popped in, turned in my prescription, was given a 40% discount off the marked price thanks to my segurança social number, and off I went.

Nationalized medicine!  What an amazing experience.  Within one hour I was issued a prescription and got the medicine I needed for the economical price of 10€!  Two euros for the appointment and another eight for the meds.  What’s to complain?! 

Well, this isolated situation was in fact very smooth but next week during normal business hours, I will have to go back and officially enroll and choose my ‘family’ doctor, whom I would visit in the event of any medical need before being transferred over to the subsequent specialist, should it be necessary. It’s a bit like an HMO at that point.  And that’s when the bureaucracy and headaches roll in as well.  I’ll never forget my first Portuguese teacher telling me, two weeks after my arrival to the country, that she had once waited 7 years for a surgery.  Her name went on the waiting list when she was 12 and it wasn’t called up until she was 19.  Now that is frightening.

Flawed as it may be, at least it is available.  Nothing is for free though. You are obligated by law to pay into the heath insurance system (segurança social) on a monthly basis.  The minimum contribution runs between 80 to 95€, which means that a laborer earning the minimal wage of 400€ per month is spending almost one quarter of his/her salary on health care.  Doesn’t quite sound right.  My own case is a bit of a conundrum, as my one-year residency permit entitles me to a one-year exemption for paying as well as an exemption from receiving/ redeeming services.  However, nobody can be denied healthcare, regardless if you’ve paid or not.  You show up and eventually you will be seen.

After recently seeing Michael Moore’s PSYCHO, this little experience of mine certainly raises some poignant questions. 


~ by maureenmoore on October 28, 2008.

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