The retired business manager could afford private care, but prefers crowded, noisy Santa Maria because of the quality of treatment on the national health service. As well as social security contributions, patients typically pay a small amount. “I’ll be charged a few euros today, but I’d be happy to pay more,” he said.

How much the Portuguese are prepared to pay for public health, education and welfare services has become the focus of national debate after warnings from Pedro Passos Coelho, the prime minister, that the country’s economic future depends on root-and-branch reform of what the state provides.