International Public Health and Biostatistics Unit, Centro de Malária e, Doenças Tropicais, and WHO Collaborating Center for Health Workforce, Policy and Planning, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal.
Int J Health Plann Manage. 2012 Oct-Dec;27(4):295-307. doi: 10.1002/hpm.2111. Epub 2012 May 30.
The primary healthcare reform in Portugal is based on the development of a new management model and clinical governance framework. The objective is to strengthen primary healthcare services to reduce the inappropriate utilization of secondary and emergency services and to make efficiency gains and to better control costs. New interventions include the introduction of a system of production-based incentives for family health units. This paper presents an initial assessment of the implementation of the new policies and tries to explain the gap between its expected results and what was observed in the field 5 years later. We used a Strengths, Weaknesses, Opportunities, and Threats analysis conducted in 12 regions, to collect the perceptions of members of Clinical Councils of Health Centers Groups, responsible for the implementation of the reform. The analysis looked at the dimensions of coverage, productivity, technical quality, and service quality. It identifies weaknesses in human resources management (shortages, incentives, team management) and lack of support from central and regional management. There is a perceived gap between the framework for reform as defined by law and the support made available for its implementation, leading to tensions between decision makers, managers, and health professionals.
葡萄牙的初级卫生保健改革基于新的管理模式和临床治理框架的发展。其目标是加强初级卫生保健服务，减少对二级和急诊服务的不适当利用，并提高效率和更好地控制成本。新的干预措施包括引入基于生产的家庭健康单位激励制度。本文对新政策的实施进行了初步评估，并试图解释其预期结果与 5 年后实际观察到的结果之间的差距。我们使用了在 12 个地区进行的优势、劣势、机会和威胁分析，收集负责实施改革的卫生中心小组临床委员会成员的意见。分析着眼于覆盖范围、生产力、技术质量和服务质量等方面。它发现人力资源管理（短缺、激励措施、团队管理）方面存在弱点，以及中央和地区管理层缺乏支持。法律规定的改革框架与为实施改革提供的支持之间存在差距，导致决策者、管理者和卫生专业人员之间存在紧张关系。
