Family Health Unit, Unidade de Saúde Familiar Prelada, ACES Porto Ocidental, Portugal; PHC- Commissioning Department, Northern Regional Administration of Health, Portugal; CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal.
CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal; Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal.
Health Policy. 2021 Jun;125(6):709-716. doi: 10.1016/j.healthpol.2021.02.008. Epub 2021 Feb 26.
Portugal underwent a paradigmatic Primary Health Care (PHC) reform in 2005. The reform implemented better health information systems, goal-oriented management, pay-for-performance schemes, functional autonomy for the front-line units, and the general adoption of commissioning processes. Since the implementation of the reform, the same set of indicators have been monitored nationally every year. However, from 2014-2016, the five Regional Health Administrations could individually select part of set of indicators to be commissioned. As the same some indicators were used commissioned in some regions, but not in others, a natural experimental setting to observe the impact of commissioning on the results by comparing the performance of commissioned versus non-commissioned indicators emerged and the effects of commissioning on PHC performance could be evaluated.
Our article aims to clarify the effect of commissioning on the results achieved by PHC units in Portugal following the implementation of the reform.
In general, the indicator values improved with time in the three types of units that existed after the reform. However, Model B Family Health Units ('Unidades de Saúde Familiar' or USFs that use pay-for-performance and are more mature) obtained the highest absolute indicator values, followed by Model A USFs (newer units with a fixed salary) and Personalised Health Care Units ('Unidades de Cuidados de Saúde Personalizados' that were created under the model before the reform and offer a fixed salary), respectively.
The results show a general increase in indicators in all PHC units. However, the indicators used in the commissioning processes exhibited a greater increase. There was no evidence that the better results exhibited by the commissioned indicators were achieved at the expense of a detrimental effect on non-commissioned indicators.
葡萄牙于 2005 年进行了一次典范性的初级卫生保健（PHC）改革。该改革实施了更好的卫生信息系统、目标管理、按绩效付费计划、一线单位的职能自主以及普遍采用委托过程。自改革实施以来，每年全国都在监测相同的一组指标。然而，从 2014 年至 2016 年，五个区域卫生管理局可以单独选择部分指标进行委托。由于一些相同的指标在一些地区被委托，而在其他地区则没有，因此出现了一种自然实验环境，可以通过比较委托指标和非委托指标的绩效来观察委托对结果的影响，从而可以评估委托对 PHC 绩效的影响。
我们的文章旨在阐明委托对葡萄牙改革后 PHC 单位取得成果的影响。
一般来说，改革后存在的三种类型的单位的指标值随时间而提高。然而，B 型家庭健康单位（使用按绩效付费且更成熟的“Unidades de Saúde Familiar”）获得了最高的绝对指标值，其次是 A 型 USF（新的固定工资单位）和个性化保健单位（在改革前的模式下创建的并提供固定工资的“Unidades de Cuidados de Saúde Personalizados”）。
结果表明所有 PHC 单位的指标都普遍增加。然而，委托过程中使用的指标增长幅度更大。没有证据表明委托指标表现出更好的结果是以牺牲非委托指标的不利影响为代价的。
