In several areas, non-public hospital care is provided by a single operator, raising competition concerns.

Across the NUTS II Oeste, Vale do Tejo, and Greater Lisbon regions, 68%, 64%, and related shares of municipalities face potential competition concerns affecting 65% and 71% of their populations respectively.

Entry barriers include a regulatory framework and high investment and licensing costs, which favor established groups.

These barriers contribute to rising concentration since 2024 as entrenched groups solidify their dominance.

The ERS emphasizes ongoing monitoring, issue-specific opinions, and recommendations to balance care quality with consumer protection.

The private hospital sector has grown to 2.905 billion euros in 2023, about 11% of current health expenditure, up from roughly 1.855 billion in 2015, with financing mainly from households and health insurance.

Compared with 2024, regional concentration rose notably in Oeste, Vale do Tejo, and Greater Lisbon.

The ERS 2025 study analyzes competition in continental Portugal’s non-public hospitals, detailing structure and dynamics during late July to early August 2025.

Higher concentration regions grant operators stronger negotiating power with SNS, potentially driving prices up and reducing offer diversity, signaling need for continued monitoring.

Four large private groups control about two-thirds of installed capacity, indicating limited competitive diversity and greater market power.

Since 2015, ERS has issued 33 competition appraisals, 17 involving private hospital operators, with most concentration-related operations not showing market concerns but ongoing monitoring deemed essential.

ERS notes that competition can lead to lower prices, more innovation, and higher quality, reinforcing the case for continued oversight to protect patient access and care standards.