Government approves National Health Service reference framework for 2026-2028

The Government has approved the global reference framework (GRF) of the National Health Service (SNS) for the 2026-2028 triennium, through Order no. 10981-A/2026, published in the Diário da República on September 4, 2026. The decree, signed by the Minister of State and Finance, Joaquim Miranda Sarmento, and the Minister of Health, Ana Paula Martins, takes effect on January 1, 2026.

The order falls under Decree-Law no. 52/2022, of August 4, which establishes the model of sectoral and financial oversight of the SNS, and articles 67.º-A and 67.º-B, which create, respectively, the GRF and the Organizational Development Plan (PDO) for public business entities. The proposal was prepared by the Executive Directorate of the SNS, I. P. (DE-SNS), in accordance with the instructions of the 2025-2027 GRF, approved by Order no. 14012/2025, of November 25, and maintains the validity of the instructions for revision in the 2027 and 2028 fiscal years.

Instructions for the triennium

Annex I of the order defines the instructions that SNS entities must comply with in four areas, aiming for a gradual improvement in levels of access, production, quality, efficiency, and integration of care:

• Healthcare performance — gradual improvement throughout the triennium.
• Economic-financial performance — revenue aligned with the State Budget and a gradual reduction in the growth rate of expenditure.
• Human resources — reinforcement of up to 1.4% of the number of workers in 2026, compared to those existing as of December 31, 2025.
• Investment plan — multi-annual plan, with the exception of investments from the Recovery and Resilience Plan (PRR), which are subject to a simplified regime.

Healthcare and access targets

Annex II sets the indicators for the triennium. In the healthcare plan, the SNS expects to grow from 47.78 million medical consultations in 2026 to 48.74 million in 2028, and from 799,499 surgeries to 831,799 over the same period. Urgent episodes are expected to decrease from 4.59 million to 4.28 million.

• Percentage of users with an assigned family doctor: 85.37% in 2026, maintained until 2028.
• Outpatient surgeries for procedures that tend to be outpatient-based: from 32.32% (2026) to 40.26% (2028).
• Coverage of oncological screenings: from 33.20% (2026) to 59.60% (2028).
• Readmissions within 30 days: from 4.06% to 3.84%.

Financial sustainability

In the financial plan, the total revenue of the SNS is expected to rise from 17,687 million euros in 2026 to 18,736 million in 2028, while total expenditure will increase from 18,498 to 19,714 million. The SNS balance, negative by 811 million euros in 2026, is expected to worsen slightly to 978 million in 2028.

• Total debt: from 891 million euros (2026) to 785 million (2028).
• Overdue payments: from 13 million (2026) to 12 million (2028).
• Average payment term: from 51 days (2026) to 50 days (2028).

Human resources and investment

The SNS workforce is expected to grow from 157,080 workers in 2026 to 160,242 in 2028, and the number of specialist doctors per 100,000 registered users will increase from 208.06 to 213.26. Current expenditure per registered user will rise from 1,620.71 euros to 1,740.90 euros over the three-year period, while the investment execution rate is expected to drop from 69.71% to 58.77%.

The order aims to ensure stability and predictability for SNS units, allowing them, within their management autonomy, to implement the Government’s strategy for the sector. For users, the document translates into concrete goals for access to consultations, surgeries, and screenings, and for hospital management, a defined financial and human resources framework for the next three years.

Source: Diário da República, 2nd series, Supplement, no. 172, September 4, 2026 (official reference: Order no. 10981-A/2026).