There are users who have to travel 1h17m to be able to carry out clinical analyses, especially those who live in inland or peripheral areas, such as Trás-os-Montes and Alentejo, but also on the coast, such as Algarve, and where the principle of equity, giving all users of the National Health Service (SNS), the same care “is being called into question”.
The complaint is made by the National Association of Clinical Analysis Laboratories (ANL), which supports its argument on data recently released by the Health sector regulator itself. In other words, reveals the Health Regulatory Entity (ERS), from 2023 to 2024, the distance to travel for an NHS user to access a clinical analysis center has increased by ten minutes (from 1h07m to 1h17m). But not only. The same data also reveals that in the space of a year there are 227 analysis centers that no longer have an agreement with the SNS and more municipalities in the country without this type of care.
The general director of ANL, Nuno Marques, highlights to DN that “this ERS data confirms the warnings we have been making about there being a real risk that SNS users may lose access to complementary diagnostic means, namely clinical analyses”.
At the base of the situation is the fact that the State “does not update the prices it has paid to those under contract for 13, 14 or 15 years. A price, and it must be said, that is also defined unilaterally”.
At this moment, he reports, there are “situations in which the price paid by the State does not even cover the cost of the act itself”. Nuno Marques confirms to DN that the current Ministry of Health should update the tables paid to contracted parties by the end of this year, but “so far we have no information that this will happen”.
For this reason, in a month, the ANL released two statements, the last one this Thursday, the 11th, with the aim of alerting government officials and the population to this “situation, which is serious”, reinforces Nuno Marques. “Someone has to act”, otherwise, “the State itself will soon be in trouble”, he assumes.
Why? “Because the network of partners that took 40 years to build will be completely dismantled”, he explains to DN, leaving behind principles such as “equity and equality in the coverage of care for all NHS users”. Which, he emphasizes, “at this moment, is already visible”.
According to the balance made by the ERS, from 2023 to 2024, the number of establishments with agreements in the area of clinical analysis reduced by 23%, from 990 to 763. In 2025, whether there were centers leaving agreements with the SNS will only be determined by the ERS at the end of the year, but the ANL believes that this number will reduce again. “We believe it is worse”, as “there are more centers giving up on the agreement with the SNS or closing to integrate large laboratories”, says Nuno Marques.
In terms of territorial coverage, ERS data confirm that, in 2024, there were already 73 municipalities without a single agreed care provider, whereas, in 2023, there were 57 – “in a single year, an additional 6% of territorial coverage was lost”, he also highlights, remembering that the blood collection stations in the network of those agreed ensure annually more than “100 million exams, around 14 million users, of which 55% exclusively SNS beneficiaries”.
Nuno Marques also points out that we cannot forget that “clinical analyzes play a fundamental role in the care response, between 70% and 80% of clinical decisions depend directly on laboratory results and 95% of care paths involve clinical pathology or pathological anatomy examinations”.
Hence, he argues that “a model of close collaboration between the SNS and the agreed sector is important, whose complementarity has made it possible to ensure timely diagnosis and territorial equity”. As he explains, it has been this joint activity that now makes ANL feel that it has a “duty to prevent irreversible damage from occurring in this area. The State cannot believe that it has not changed prices for more than a decade and that this does not cause damage to the network that was built and the sustainability of small laboratories”.
The problem takes on another dimension when “in the same places where small laboratories disappear, processes of internalization appear at the same time” – that is, “large laboratories that cluster the centers that were passed from generation to generation, leading, as the ERS says, to market concentration”.
Nuno Marques explains to DN that “larger providers operate in large-scale economies and are better able to withstand not updating prices. Smaller providers have to cover expenses with at least ten employees and are not as efficient, so to speak, in managing the impact of not updating prices on their activity”. In fact, he says, in a few years, “Portugal could be like Spain, dependent on two to three large groups”.
For the sector representative, “we cannot call into question the access of SNS users to this care. We cannot just think about coastal areas or large cities where access may be facilitated by the number of existing stations. We have to think that the more than 3,400 points in the network of partners are at risk. It is not just us who say this, the ERS confirms this too. And what is at stake is that they no longer have an agreement with the SNS and someone stops having care. It is necessary to act, a strategy is needed to ensure that the relationship between the SNS and the agreed sector is not lost”, argues Nuno Marques.