Lapão Luís Velez, Pisco Luís
Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal.
WHO Collaborating Center for Health Workforce Policy and Planning, Lisboa, Portugal.
Cad Saude Publica. 2019 Aug 12;35Suppl 2(Suppl 2):e00042418. doi: 10.1590/0102-311X00042418.
In order to reform Portugal's primary health care (PHC), the Ministry of Health planned a change that was launched in 2005 and 2006, and which is still under way today. This article aims to analyze PHC reform in Portugal according to different phases in its development, using Kingdon's multiple streams model to reflect on the evolution in the reform process and its future, from the perspective of a process that seeks to achieve universal access to health. The working methodology was a document and case study with a qualitative approach and evaluative dimensions. The study was based on material on PHC in Portugal, published both in Portugal and elsewhere. Kingdon's multiple streams model was used to explain the actual and contextual development of policies implemented during the PHC reform. Three phases were identified in the reform, each lasting about five years. The first phase, starting in 2005, featured family health units with a voluntary basis. The second phase began in 2010, with the model's consolidation. In the third phase, since 2015 and still under way, the model came of age, benefiting from the end of the financial crisis but still suffering from its effects. The three reform cycles represent three distinct periods with consistency in the coalition that the policymaker was able to establish, in which the windows of opportunity for internally built change were heavily influenced by external factors. The article identifies the contribution by PHC reform to improvement of the Portuguese population's health status.
为了改革葡萄牙的初级卫生保健（PHC），卫生部计划了一项于2005年和2006年启动且至今仍在进行的变革。本文旨在根据葡萄牙初级卫生保健改革发展的不同阶段对其进行分析，运用金登的多源流模型，从寻求实现全民健康覆盖的进程角度，反思改革进程的演变及其未来。工作方法是采用定性方法和评估维度的文献及案例研究。该研究基于葡萄牙国内外发表的有关葡萄牙初级卫生保健的资料。金登的多源流模型被用于解释初级卫生保健改革期间实施政策的实际和背景发展情况。改革确定了三个阶段，每个阶段持续约五年。第一阶段始于2005年，以自愿为基础设立家庭健康单位。第二阶段于2010年开始，对该模式进行巩固。在第三阶段，自2015年起至今仍在进行，该模式走向成熟，受益于金融危机的结束，但仍受其影响。这三个改革周期代表了三个不同时期，政策制定者能够建立起具有连贯性的联盟，其中内部变革的机会之窗受到外部因素的严重影响。本文确定了初级卫生保健改革对改善葡萄牙民众健康状况的贡献。
