de Oliveira Ana Paula Cavalcante, Dussault Gilles, Craveiro Isabel
Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira, 100, 1349-008, Lisbon, Portugal.
Hum Resour Health. 2017 Mar 23;15(1):24. doi: 10.1186/s12960-017-0194-3.
Shortages of physicians in remote, rural and other underserved areas and lack of general practitioners limit access to health services. The aims of this article are to identify the challenges faced by policy and decision-makers in Portugal to guarantee the availability and geographic accessibility to physicians in the National Health Service and to describe and analyse their causes, the strategies to tackle them and their results. We also raise the issue of whether research evidence was used or not in the process of policy development.
We analysed policy and technical documents, peer-reviewed papers and newspaper articles from 1995 to 2015 through a structured search of government websites, Portuguese online newspapers and PubMed and Virtual Health Library (Biblioteca Virtual em Saúde (BVS)) databases; key informants were consulted to validate and complement the documentary search.
The challenges faced by decision-makers to ensure access to physicians were identified as a forecasted shortage of physicians, geographical imbalances and maldistribution of physicians by level of care. To date, no human resources for health policy has been formulated, in spite of most documents reviewed stating that it is needed. On the other hand, various isolated and ad hoc strategies have been adopted, such as incentives to choose family health as a specialty or to work in an underserved region and recruitment of foreign physicians through bilateral agreements.
Health workforce research in Portugal is scarce, and therefore, policy decisions regarding the availability and accessibility of physicians are not based on evidence. The policy interventions described in this paper should be evaluated, which would be a good starting point to inform health workforce policy development.
偏远农村及其他医疗服务不足地区的医生短缺，且全科医生匮乏，限制了人们获得医疗服务的机会。本文旨在确定葡萄牙政策制定者和决策者在确保国家医疗服务体系中医生的可获得性和地理可及性方面所面临的挑战，并描述和分析其成因、应对策略及结果。我们还提出了在政策制定过程中是否使用了研究证据这一问题。
我们通过对政府网站、葡萄牙在线报纸以及PubMed和虚拟健康图书馆（Biblioteca Virtual em Saúde (BVS)）数据库进行结构化检索，分析了1995年至2015年期间的政策和技术文件、同行评议论文及报纸文章；咨询了关键信息提供者以验证和补充文献检索结果。
决策者在确保医生可及性方面面临的挑战被确定为预计的医生短缺、地理失衡以及不同医疗级别医生分布不均。尽管大多数所审查的文件都表明需要制定卫生人力资源政策，但迄今为止尚未制定。另一方面，已采取了各种孤立的临时策略，例如激励人们选择家庭医疗作为专业或到医疗服务不足地区工作，以及通过双边协议招聘外国医生。
葡萄牙的卫生人力研究匮乏，因此，关于医生可获得性和可及性的政策决策并非基于证据。应对本文所述的政策干预措施进行评估，这将是为卫生人力政策制定提供信息的一个良好起点。
