School of Sociology and Public Policies, ISCTE-Instituto Universitário de Lisboa, Av Forcas Armadas, 1649-026, Lisbon, Portugal.
Portuguese Medical Council, Av Almirante Gago Coutinho, 151, 1749-084, Lisbon, Portugal.
Hum Resour Health. 2017 Dec 12;15(1):82. doi: 10.1186/s12960-017-0256-6.
The European Union member countries reacted differently to the 2008 economic and financial crisis. However, few countries have monitored the outcomes of their policy responses, and there is therefore little evidence as to whether or not savings undermined the performance of health systems. We discuss the situation in Portugal, where a financial adjustment program was implemented between 2011 and 2014, and explore the views of health workers on the effects of austerity measures on quality of care delivery.
A nationwide survey of physicians' experiences was conducted in 2013-2014 (n = 3442). We used a two-step model to compare public and private services and look at the possible moderating effects of the physicians' specialty and years of practice. Our data analysis included descriptive statistics, the independent t test, analysis of variance (ANOVA), multivariate logistic regression, General Linear Model Univariate Analysis, non-parametric methods (bootstrap), and post hoc probing.
Mainly in the public sector, the policy goal of maintaining quality of care was undermined by a lack of resources, the deterioration in medical residency conditions, and to a lesser extent, greater administrative interference in clinical decision-making. Differences in public and private services showed that the effects of the austerity measures were not the same throughout the health system. Our results also showed that physicians with similar years of practice and in the same medical specialty did not necessarily experience the same pressures.
The debate on the effects of austerity measures should focus more closely on health workers' concrete experiences, as they demonstrate the non-linearity between policy setting and expected outcomes. We also suggest that it is necessary to explore the interplay between lower quality and the undermining of trust relationships in health.
欧盟成员国对 2008 年的经济和金融危机做出了不同的反应。然而，很少有国家监测其政策反应的结果，因此几乎没有证据表明储蓄是否会损害卫生系统的绩效。我们讨论了葡萄牙的情况，该国在 2011 年至 2014 年期间实施了一项财政调整计划，并探讨了卫生工作者对紧缩措施对提供护理质量的影响的看法。
我们于 2013-2014 年对医生的经历进行了全国性调查（n=3442）。我们使用两步模型来比较公共和私人服务，并研究医生的专业和实践年限的可能调节作用。我们的数据分析包括描述性统计、独立 t 检验、方差分析（ANOVA）、多变量逻辑回归、广义线性模型单变量分析、非参数方法（自举）和事后探测。
主要在公共部门，由于资源匮乏、住院医师条件恶化，以及在较小程度上，临床决策中的行政干预增加，维持护理质量的政策目标受到了损害。公共和私人服务之间的差异表明，紧缩措施的影响在整个卫生系统中并不相同。我们的结果还表明，具有相似实践年限和相同医学专业的医生并不一定面临相同的压力。
关于紧缩措施影响的辩论应更密切地关注卫生工作者的具体经验，因为这些经验表明政策制定和预期结果之间存在非线性关系。我们还建议，有必要探讨质量下降和破坏卫生信任关系之间的相互作用。
