PORTUGAL A PRIVILEGED DESTINATION FOR

Contents

- Manuel Caldeira Cabral – Minister of Economy - Adalberto Campos Fernandes – Minister of Health - Salvador de Mello - President of Health Cluster - Portugal - A Privileged Destination - - Areas of excellence in Portuguese Healthcare - & Cardiac Surgery - Orthopedics - Rehabilitation - - - Obesity - - OB/GYN - Assisted Reproductive Technology - Check-ups - Portugal facts and figures - How to get in touch or find out more MEDICAL

Terminal de Cruzeiros do de Leixões Manuel Caldeira Cabral Minister of Economy

In the past few years, Portugal has established itself as one of the best touristic destinations all across the world. The growth of this sector in our country has been a major key for the wealth creation in Portugal, and one of the main drivers for our economy. Last year, 2017, we broke new records again – revenue increased 20%, something we had not seen in the last two decades. So strong is the performance of tourism in Portugal that it accounts for more than half the services exports and 18% of the exports of goods and services. Last year, overall, Portuguese exports kept growing and represented 42,5% of our GDP, a new record, which clearly shows how sustainable and resilient the Portuguese economy is. We are also aware that the demand for high quality health treatments is growing, namely because of demographics, and we have identified that as a priority in our National Strategy for Tourism 2027. We have some of the best qualified doctors and nurses and modern and functional medical infrastructures that are able to serve both locals and tourists. Our healthcare system is recognized internationally for its universal character, we have thousands of hours of sunshine every year, we are in a strategic geographic location and we have 166 thousand rooms in modern and comfortable hotels. For all these reasons, we elected “Well-Being” as an emerging asset in our strategy for 2027 and we are working on new ways to become more attractive for those who come here looking for the best treatments. Adalberto Campos Fernandes Minister of Health

In the last decade, medical tourism has grown significantly worldwide. New technologies, changing demographics, globalization and access to unprecedented amounts of information all converge and influence how we view the world. Also the improvement of transport facilities, mainly airborne, will continue to facilitate access to tourism and its development. Decision makers are improving healthcare systems through the use of information and communications technologies, investing in safe and quality units, thus making it attractive to engage with tourism flows. It is time to pool and to link available knowledge and experience across the world, providing a strategic overview regarding the nature of patient movement, including data on tourism-related flows and long-term stay. Those who visit us have available healthcare services safe and of high quality. Portugal aims to be a relevant destiny for medical tourism, engaging tourism and healthcare services. We need to achieve this objective in a balanced and sensible way. In both areas, Portugal has a prominent role and is at the top of the list. Portugal has a sound healthcare system according to international standards, one of the best of the world at top 20, encompassing public and private sector, confirming a good performance. Portugal stands out for its quality and international acknowledgement and several international awards awarded for the tourism sector promote Portugal as a most popular and famous attractive destiny.

You are most welcome both as a patient and as a tourist. Salvador de Mello President of Health Cluster Portugal

Health became one of the most precious assets of mankind which has been witnessing remarkable achievements in the last decades. These overall improvements have largely resulted from better living conditions, major developments in medical science and a number of population-level interventions but, most of all, from the relentless work of health professionals, scientists, managers, and other men and women who, in an increasingly complex ecosystem, find the proper balance and the right answers among various realities. In Portugal, healthcare is unquestionably an area of successful collective investment as demonstrated by the excellent performance indicators of its scientific production, associated business dynamics and, above all, of its national health system. These accomplishments, combined with the commitment that unites all the relevant players along the entire value chain - from the government and public agencies to caregivers – position Portugal as a high quality medical tourism destination. For those looking for the highest level of medical care and unique opportunities for convalescence and recovery in a particularly attractive and welcoming environment, Portugal is the right place.

We are looking forward to your visit. Portugal A Privileged Destination

Portugal has been known for centuries as a country of some of the world’s greatest explorers. Now, it seems that the world is rediscovering Portugal with ever more interest, and a virtual boom in tourism, relocation, and investment from abroad. There are many reasons why Portugal may easily be called a privileged destination, among which include: 3000 hours of sunshine a year, 850 km of white sandy beaches, fresh Mediterranean gastronomy, numerous opportunities for adventure and outside living, welcoming and friendly people, an undeniable harmony that places Portugal 3rd on the World Peace Index, and one of the more favorable costs of living in western Europe, among many more qualities.

International awards, rankings and notoriety of Portugal in recent years reflect this new discovery moment in the country. The tourism sector in Portugal has registered successive annual double-digit growth. In 2016, Portugal was recognized with 491 awards and distinctions, and in 2017, Portugal claimed the title of World’s Leading Destination, World’s Leading Beach Destination, and Europe’s Leading Destination from the World Travel Awards. Portugal receives approximately 13 million international tourists annually, who report a degree of satisfaction above 90%. Portugal is gaining increasing recognition as great place to retire. According to Forbes, the country is the 9th best place in the world to retire. High quality health services, tax benefits for international retirees, warmer weather, and affordable housing and cost of living have been mentioned as key factors in choosing Portugal for retirement. The Annual Global Retirement Index by International Living Magazine ranked Portugal as the 7th best country in the world to retire in 2018, and the highest ranking European country on the list. Live and Invest Overseas’ rated as the number 1 city to retire in 2018. Portugal is also considered the world’s second best country with regards to the integration capacity of immigrants (Migrant Integration Policy Index).

Portugal supports patients travelling for care with a high level of client support, quality and breadth of the healthcare services availab- le, direct air links to/from many of the world’s capital cities, and comprehensive and diverse tourist services. The affordable cost of living in the country also makes Portugal an attractive location for longer stays for rehabilitation and recovery. Around 70 spas throughout the country of recognized therapeutic value present a holistic option for physical and mental recovery. And with nearly 70 thousand hotel rooms in establishments ranging from historic to modern, Portuguese or international, family friendly or five star, and resort styles, it is easy to find a comfortable place to call home while in Portugal. Healthcare in Portugal

The health sector is a prominent, fast-evolving sector in Portugal, which has experienced remarkable growth over the last two decades. The healthcare system in Portugal offers highly skilled clinical professionals, newly built and recently renovated infrastructure, advanced equipment and technologies, contributions to clinical research, and a commitment to continued training and innovation, placing the health system in Portugal on the level among the best that Europe has to offer. This is reflected in the main international rankings, where the Portuguese healthcare system is usually in the top twenty positions. Regular quality assessments performed by an independent national regulatory body in addition to the growing number of international accreditations being achieved in the country play an important role in supporting continued performance improvements. The quality of the physicians and other healthcare professionals is maintained by an education that is only accessible to the best students, and which typically includes an intensive and long training process that is internationally recognized. Increasingly, medical professionals trained in Portugal are being recruited by major European countries, or will serve in prestigious positions in various countries and European medical societies.

In addition to the technical-scientific component, Portuguese healthcare professionals are well-known for their humanized, friendly, gentle and warm way of receiving patients, forging personalized and considerate relationships, as well as by their fluency in foreign languages.

Portugal has a vibrant and innovative research & development ecosystem in the field of life sciences, characterized by the presence of world-class institutions and scientists in the areas of neurosciences, , immunology, regenerative medicine and nanomedicine.

The health indicators achieved in Portugal are the best evidence of the quality of its healthcare system, which has, for example, one of the highest average life expectancies at birth, one of the lowest risks of premature death from chronic diseases and higher than average survival rates after diagnosis of some higher incidence . Torre de Belém, Lisboa Areas of excellence in Portuguese Healthcare

Healthcare services for patients travelling from abroad are most commonly provided in the most reputable private in Portugal. Several hospitals now work in collaboration with the Health Cluster Portugal in order to promote their combined expertise internationally.

The Portuguese private hospitals participating in this collaboration are general acute care hospitals with all specialties and differentiated multidisciplinary clinical centers, emergency rooms, ICU, modern operating theaters and complementary services.

All employ high caliber physicians, invest in the latest information and clinical technology that regularly contributes to new and improved approaches to medicine in Portugal, and share their expertise internationally.

The following clinical areas are considered among the best performing. Often multidisciplinary in nature, these clinical centers receive continual investment and national recognition, as well as being those most sought by international patients seeking care in Portugal.

To find out which hospitals participate in Medical Tourism in Portugal, learn more about their services, and for specific contact information of each, please visit www.medicaltourisminportugal.com

Cardiology & Cardiac Surgery Working at the forefront of medicine in the diagnosis and treatment of heart disease

The Cardiovascular Centers in the Portuguese private hospitals offers patients a comprehensive service, advanced technology, and teams of highly skilled cardiologists and cardiovascular surgeons, working at the forefront of medicine in the diagnosis and treatment of heart disease.

Treating heart diseases today may involve cardiologists, interventional cardiologists and cardiac surgeons, as well as specialists in , cardiac imaging, , , , , , among others – working as a true interdisciplinary team, and in close cooperation with other hospital services such as polyvalent ICUs, the , and clinical analyses.

Portuguese Cardiovascular Centers work with renowned clinical staff and technological capacity that aims at promoting health through prevention, diagnosis and world class treatment of heart diseases including stereotactic magnetic navigation for complex angioplasty, arrhythmology procedures, and well as minimally invasive cardiac surgery.

Disease prevention is our aim. If heart disease runs in your family, if you’ve experienced symptoms, or engage in known lifestyle risk factors such as unhealthy eating, a sedentary lifestyle, or smoking, a heart checkup may be the first step in preventing heart disease from advancing. Our physicians can perform a complete assessment of your heart’s health and recommend specific actions you may take on your own or with the support of hospital staff or other services in order to prevent or manage heart disease. If you have experienced a major cardiac event, our rehabilitation programs will strengthen and enable recovery of lost capacity.

Orthopedics Move easily and be pain free!

Trauma and Orthopedics Centers in Portugal are multipurpose units, with a comprehensive approach in diagnosing and treating conditions of the locomotor system. The clinical teams include experts who are specialized in each region of the skeleton, including the spine, shoulder, elbow, wrist and hand, hip, knee, ankle and foot. Thus, these centers offer solutions to all the conditions of the musculoskeletal system.

Professional and casual athletes can also depend on the Centers for Sports Medicine. Dedicated to the prevention and treatment of problems associated with the practice of any physical activity or sport, these Centers aim to contribute to the promotion of health and well-being of all athletes, helping them to feel more secure in their physical ability to strive for their highest performance. Physicians, physiotherapists, and nutritionists work in an integrated manner and according to the specific needs of each patient. This multidisciplinary approach, in addition to all the technological and physical resources available, supports achieving excellence in the care provided.

Portuguese Hospitals also offer rehabilitation of locomotor system pathologies associated with congenital conditions, subsequent to falls, accidents at work, road accidents, sports or other activities and serious diseases, as well as following surgery.

Orthopedic rehabilitation plans result in a program tailored to each individual is developed with recommendations for specific treatments for each person given their condition and the goals that should be achieved.

Physical Medicine and Rehabilitation Services rely on teams of highly experienced rehabilitation physicians and physiotherapists who are particularly devoted to: functional diagnosis, restoring the individual’s normal function after injury or illness, as well as treating several and varied conditions, particularly focused on the use of physical and kinesiological resources. For all these reasons, the Portuguese Trauma and Orthopedics Centers are a growing reference all around.

Rehabilitation Restore physical capabilities in Portugal.

Our Rehabilitation and Convalescence Units meets the needs of patients who seek to improve or recover their physical abilities through various activities and programs so that they can again enjoy their lives with greater autonomy.

Rehabilitation exist for the following types of patients:

Patients recovering from surgery or serious illness and who no longer need to be in an acute care hospital Patients requiring medical stabilization consequent to episodes of acute exacerbations of chronic diseases Services focused on Convalescence and Rehabilitation, especially in post-acute situations, with emphasis on neurological, orthopedic, and cardiac patients, and particular focus on stroke, hip and knee surgery, general post-surgical care, among others.

Intensive personalized rehabilitation plans

Patients admitted to Rehabilitation and Convalescence Units have intensive individual rehabilitation plans, designed according to the specific needs of their clinical situation. Generally, the rehabilitation plans may include physical programs, occupational therapy, adaptive training techniques, among others. A team of specialized professionals in all areas where the patients need support work together to see the patient achieve greater autonomy and participation in all aspects of daily life.

Our Rehabilitation and Convalescence Units offers different areas of expertise to deal with a variety of problems:

Physiatrists (Rehabilitation Physicians), to conduct patient assessments and develop individual treatment plans, including doctors qualified in Acupuncture Physical Therapists, trained to restore strength, mobility, balance, and function, while reducing pain and Occupational Therapists, to help patients do daily activities themselves, such as eating, dressing, and bathing Speech Therapists, to help patients overcome speech and cognitive disorders and regain their ability to communicate

Oncology Portuguese hospitals contain every necessary resource for effective diagnosis and treatment of all types of cancers

The inherent complexity in managing oncological disease requires a comprehensive patient care philosophy. Each patient can expect their case to be managed in line with international clinical protocols supported by the latest scientific information with a great importance placed on the wellbeing of the patient throughout the process of care. This is achieved by considering the patient’s preferences, supporting the patient in unders- tanding their treatment plan, receiving care in comfort and privacy, encouraging family support and participation, and in the efficient coordination of complementary hospital services.

Our multidisciplinary approach is the cornerstone of the comprehensive cancer centers in Portugal. The principal specialties for diagnosis and treatment in this area of medicine, namely , Medical Oncology and Radiotherapy are present as well as collaboration with other medical specialties with expertise in particular types of cancer, depending on the organ system affected.

With regards to radiotherapy, Portugal has linear accelerators with potential to perform image-guided single-dose radiotherapy, as well as IMRT. We perform brachytherapy, intraoperative brachytherapy in low-risk breast cancer, as well as Gamma Knife stereotactic radiosurgery for injuries of the central nervous system. Surgical treatment is performed by highly differentiated, internationally known surgeons in technologically advanced operation theatres, including ORs prepared for minimally invasive surgery including robot-assisted surgery.

Plastic Surgery Supporting quality of life through the body’s architecture and appearance.

Aesthetic and Reconstructive Plastic Surgery is a surgical specialty that offers solutions for cosmetic complaints such as corrects morphological body changes (silhouette surgery), and anti-ageing surgery, as well as recovery through reconstruction of damages or life limiting structures, such as congenital malformations, physical development disorders, traumatic and post-traumatic lesions (including burn victims), as well as tumor lesions and related reconstruction.

Cosmetic Surgery has acquired a growing relevancy in the Western World, given the appreciation of the image by society, helping to improve self-esteem and quality of life. An obvious example for the last is breast reconstruction surgery, on which innovative techniques can be performed.

Beyond the scheduled appointments, this specialty provides 24/7 support to treat and handle situations such as complex wounds, or situations that affect important structures, or consist of loss of cutaneous substance, or even burn cases.

Obesity When you treat obesity, you effectively treat several risk factors that may limit and even shorten your life

Surgical treatment of obesity results in significant improvement of quality of life in 98% of patients. Among the benefits associated with obesity surgery, loss of weight, of course, will be the most immediate. However, the first benefit is not necessarily the greatest. The reduction in mortality and morbidity from obesity associated conditions offers the possibility for a longer and healthier life.

The surgical teams in the top Portuguese private hospitals have extensive experience in all surgical procedures currently recommended for the treatment of obesity, including minimally invasive surgery by laparoscopy and robot-assisted surgery.

Specialties involved in the multifaceted treatment of obesity include: , nutrition, clinical psychology, internal medicine, endocrinology, , general and bariatric surgery, anesthesiology, reconstructive and aesthetic plastic surgery.

Other specialties may also collaborate in the treatment of obesity, in particular: cardiology, physical medicine and rehabilitation, orthopedics, , , the clinical laboratory and the ICU.

Ophthalmology Good eye sight is the most precious gift for experiencing life

Ophthalmology in Portugal has advanced significantly during recent years. We offer state of the art technology with multidisciplinary teams specialized in all the different areas of eye care such as retina, glaucoma, cataract and refractive surgery, pediatric ophthalmology, orbit and oculoplastics.

Portuguese ophthalmologists have excellent training and are consistently among the best in the European Board of Ophthalmology exam in the last five years.

Outcomes in Cataract Surgery in Portugal are currently being submitted to the ICHOM Project (International Consortium for Health Outcomes Measurement).

When Eye Problems are Part of Another Condition

Sometimes, eye diseases are related to a systemic condition such as rheumatoid arthritis, diabetes, cardiovascular disease, thyroid disease or cancer. When this occurs, our hospitals we work to integrate ophthalmologic treatment into the patient’s total care plan.

Obstetrics & Delivering the very best care for women and new life

Private hospitals in Portugal are prepared to support women throughout their adult lives through a comprehensive, high quality and patient centered approach to women’s health.

In , high quality clinical assistance during pregnancy and childbirth is reflected in very good neonatal health indicators for Portugal in comparison to other EU countries. Our hospitals provide pregnancy surveillance and prenatal diagnostics in both normal and high risk pregnancies. The design and comforts found in our labor and delivery rooms, as well as our maternity suites supports the family’s celebration for welcoming their new lives into the world.

Maximizing comfort and supporting parent’s confidence is evident throughout this experience in Portuguese private hospitals. Expecting parents have the possibility to visit the maternity services accompanied by experienced maternity nurses at any time in the course of the pregnancy in order to feel at ease with the environment in which the birth will occur. Private rooms with beautifully decorated cots for newborns, welcome care packages for mothers, comfortable accommodation for fathers, breast feeding support, prenatal birth classes, post-natal support during the first month of life, and on site birth registration are just some of the features of a service that guides as well as delivers.

Gynecological services offer a complete surveillance of women's health at all stages of their lives, including oncological disease screening and menopause surveillance. Expert surgeons perform conventional, hysteroscopic and laparoscopic gynecological surgery.

Our OB/GYN physicians participate in the most relevant international societies. From offering endoscopic courses and performing live surgery via the web, to assuming leadership positions in the societies, they maintain a high level of international engagement.

Assisted Reproductive Technology A grand adventure is about to begin. – Winnie the Pooh

Also known as reproductive technology, this is the medical specialty dedicated to the use of technology to achieve pregnancy when a couple is unable to conceive naturally. The definition of infertility is, according to the World Health Organization, the absence of pregnancy after a full year of unprotected intercourse.

In order to help a couple achieve pregnancy several exams and treatments can be performed from diagnosis, fertility tests, full couples’ studies, medical-surgical and assisted reproductive technology (ART).

These techniques increase the probability of couples achieving their dream of becoming parents.

Check-up Take care of your body.

Preventive medicine, including education about healthy lifestyles and regular check ups is the best way to promote a long and healthy life. Busy lifestyles often make it difficult for people to schedule time for activities that support their continued well-being. Your health is your greatest asset, and maintaining it should be at the top of your priority list. Get out into nature, breathe fresh air, relax in unique spa environments, and learn and manage how your body is functioning through specially designed and convenient check-up programs.

During a stay in Lisbon, it’s easy to do something to support your continued well-being. A comprehensive medical evaluation can help find problems before they start. Consider one of several efficient check-up packages. In Portuguese hospitals, it is possible to do a program of tests, exams, and consultations designed for you with the possibility to discuss all the results and advise with a physician at the end of the program.

If you want to investigate specific areas of health that matter to you, tailor your check-up to fit your needs. Our focused clinical investigations consider health issues for age, sex, and specific organ systems. The Health Cluster Portugal (HCP) has as its main objective the promotion and implementation of initiatives and activities leading to the consolidation of a national cluster for competitiveness, innovation and technology, with an international outlook and, as such, taking into account high standards of quality and professionalism, to promote and foster cooperation between companies, organizations, universities and public entities, with a view to increase business volume, exports and qualified employment, in the economic areas related to health and to the improvement of health care.

Acknowledgments: HCP greatly appreciates the generous contributions to the content and editing of this brochure by member healthcare companies, Luz Saúde, Lusíadas, and CUF. Money Currency Portugal is one of 19 European Union countries whose common official currency is the euro.

ATMs - Automatic Teller Machines (Multibanco) Portugal has a national network of cash machines (ATMs) identified by the symbol MB (Multibanco), from which you can withdraw cash 24 hours a day.

Currency Exchange You can exchange money at banks, at bureaux de change; and at automatic currency exchange machines.

Credit cards In Portugal, the most commonly used credit cards are: Visa, American Express, Diners Club, Europay / MasterCard, JCB and Maestro.

Transports Air Portugal’s excellent geographical position makes it a stopover point for many foreign airlines at airports all over the country:

Rail CP - Comboios de Portugal (www.cp.pt), the Portuguese railway company, offers a vast rail network covering the whole of mainland Portugal and also offers international train services to Vigo, Madrid and Paris.

Road Portugal has a good road network composed of Motorways (AE), Main Trunk Routes (IP), Complemetary Trunk Routes (IC), Main (National) Roads (EN) and Secondary (Municipal) Roads.

Underground The underground is an important addition to the traditional forms of public transport. In Lisbon and Oporto it operates between 6 a.m. and 1 a.m.

Taxis Taxis are usually cream in colour, although there are still some painted black with a green roof in the traditional Portuguese style. The fare is shown on the taximeter. The prices are affixed inside the car or you can ask the driver about them.

Electricity The electric current in Portugal is 230/400 volts at a frequency of 50 hertz and sockets comply with European standards. You will need a 230 volt transformer and an adaptor to use American-style flat-prong plugs.

Entry formalities Citizens of the European Union, Iceland, Liechtenstein, Norway and Switzerland need only an identity card to enter Portugal.

For visits of less than 90 days, a passport valid for at least three months after the end of their stay is necessary for visitors from Albania, Andorra, Antigua and Barbuda, Argentina, Australia, Bahamas, Barbados, Bosnia-Herzegovina, Brazil, Brunei, Canada, Chile, Costa Rica, Croatia, Guatemala, Holy See, Honduras, Israel, Japan, Macedonia, Malaysia, Mauritius, Mexico, Monaco, Montenegro, New Zealand, Nicaragua, Panama, Paraguay, Saint Kitts and Nevis, San Marino, Serbia, Seychelles, Singapore, South Korea, United States of America, Uruguay, Venezuela, Special Administrative Regions of the People’s Republic of China in Hong Kong and Macao and Taiwan territorial Authority. Citizens from countries not mentioned above need a visa to enter Portugal, which may be requested at the Portuguese Embassy or Consulate of their country for stays of up to 90 days. www.medicaltourisminportugal.com/en