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IMF Country Report No.26/148 PORTUGAL SELECTED ISSUES June2026 This paperonPortugalwas prepared by a staff team of the International Monetary Fundas background documentation for the periodic consultation with the member country. Copies of this report are available to the public from International Monetary Fund•Publication ServicesPO Box 92780•Washington, D.C. 20090Telephone: (202) 623-7430•Fax: (202) 623-7201E-mail:publications@imf.org Web:http://www.imf.org International Monetary Fund PORTUGAL SELECTED ISSUES May 28, 2026 ApprovedByEuropean DepartmentPrepared ByIppei Shibata(EUR)and Carolina Bloch (FAD). CONTENTS Acronyms_________________________________________________________________________________3 PORTUGAL’S PRODUCTIVITY GAP VIS-À-VIS EUROPE AND THE UNITED STATES: A.Background and Motivation___________________________________________________________4B.Challenges Faced by Firms to Scale Up in Portugal____________________________________6 FIGURES 1. Aggregate Productivity Gap: Portugal vis-à-vis Europe and the United States_________42. European Listed Firms in International Comparison: Productivity, R&D, and EquityIssuance__________________________________________________________________________________53. Firm Dynamics in Portugal_____________________________________________________________64. Gazelles in Portugal____________________________________________________________________85. Portugal’s Innovation Ecosystem______________________________________________________10 ANNEX I.DataSources___________________________________________________________________________11 HEALTH SPENDING EFFICIENCY IN PORTUGAL: DRIVERS, CHALLENGES AND A.Introduction__________________________________________________________________________13B.Healthcare Model and Spending Composition________________________________________15C.Input-Related Cost Drivers____________________________________________________________19D.System-Level and Budgeting Reforms and Constraints_______________________________21 PORTUGAL E.Conclusion and Policy Options to Enhance Health Spending Efficiency_______________________23 BOXES 1.Overview of the Portugese Health Sysem_____________________________________________________162.Portugal’s Health Spending Review: Scope and Implementation Constraints__________________23 FIGURES 1. Benchmarking and Recent Trends of Current Health Spending_______________________________142. Health Spending by Financing Schemes and Funding Sources________________________________173. Compositionof Current Health Expenditure in Portugal and EU Countries____________________184. Hospital Spending: Signs of High Costs and Continued Strain________________________________185. Contributions of Main Spending Components to SNS CHE Growth, 2019-2024_______________196. Employment and Compensation of Healthcare Professionals_________________________________20 References_______________________________________________________________________________________25 Acronyms ADMAssistência na Doença aos Militares (Health subsystem for the Armed Forces)ADSEAssistência na Doença aos Servidores do Estado (Health subsystem for civilservants)CHECurrent Health ExpenditureCRICentros de Responsabilidade Integrada (Integrated Responsibility Centers)ECGExcess Cost GrowthINFARMEDAutoridade Nacional do Medicamento e Produtos de Saúde (National Authority ofMedicines and Health Products)LTCLong-Term Care PORTUGAL’S PRODUCTIVITY GAP VIS-À-VIS EUROPEAND THE UNITED STATES:A FIRM-LEVEL ANALYSIS Portugal’slarge GDP-per-capita gap withthehighest-income euro area economies and the US isprimarily driven by a productivity shortfall. At the EU level,Europeanleading firms, particularly in thetech sector, trail leading global counterparts in productivity and innovation, partly reflecting far lessR&D investment rooted in less reliance on equity.In Portugal, those factors are compounded byabroader lack of dynamism. Firms enter the market small andrarelyscale up, resulting in a muchsmaller economic footprint of young high-growth firmsthanin European peers and—even moreso—the US. Thisrarer occurrence of “gazelles” inPortugalpartly reflects limited access to venture A.Background and Motivation Figure1. Aggregate Productivity Gap: Portugalvis-à-vis Europe and the UnitedStates TheGDP-per-capita gapvis-à-vistheUSprimarilyreflectslower total-factor productivity (TFP). Portugal lags the US and its European peers interms oflabor productivity. 1.Portugal’ssignificant per-capita income gap with the highest-income euro areaeconomies and the United States primarily reflects a wide productivity shortfall(Figure 1). In2024, Portugal’s income per capita in PPP terms stood nearly 45 and 21percent below that of theUS and the four largest euro area economies (Germany, France, Italy and Spain, or EA4), respectively. four-fifths of it. In the second half of the 20th century, European economies significantly narrowed—and some of them closed—their hourly produc