Pereira Miguel Alves, Marques Rui Cunha, Ferreira Diogo Cunha
Centro de Estudos de Gestão do Instituto Superior Técnico (CEG-IST), Instituto Superior Técnico, Universidade de Lisboa, 1049-001 Lisbon, Portugal.
Civil Engineering Research and Innovation for Sustainability (CERIS), Instituto Superior Técnico, Universidade de Lisboa, 1049-001 Lisbon, Portugal.
Healthcare (Basel). 2021 Jul 16;9(7):904. doi: 10.3390/healthcare9070904.
Over the years, the Portuguese National Health Service has undergone several reforms to face the challenges posed by internal and external factors on the access to and quality of its health services. One of its most recent reforms addressed the primary healthcare sector, where understanding the incentives behind the actors of the inherent institutional interventions and how they are aligned with the governing health policies is paramount for reformative success. With the purpose of acknowledging the alignment of the primary healthcare sector's institutional interventions from an incentive-based perspective, we propose a framework resting on a SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis, which was built in cooperation with a panel of decision-making actors from the Portuguese Ministry of Health. In the end, we derive possible policy implications and strategies. This holistic approach highlighted the positive impact of the primary healthcare reform in the upgrade of physical resources and human capital but stressed the geosocial asymmetries and the lack of intra- and inter-sectorial coordination. The proposed framework serves also as a guideline for future primary healthcare reforms, both national- and internationally.
多年来，葡萄牙国家医疗服务体系经历了几次改革，以应对内部和外部因素对其医疗服务可及性和质量所带来的挑战。其最近的一项改革针对的是初级医疗保健部门，在该部门，了解固有制度干预行为主体背后的激励因素以及这些因素如何与主导的卫生政策保持一致，对于改革的成功至关重要。为了从基于激励的角度认识初级医疗保健部门制度干预的一致性，我们提出了一个基于SWOT（优势、劣势、机会和威胁）分析的框架，该框架是与葡萄牙卫生部的一个决策行为主体小组合作构建的。最后，我们得出了可能的政策含义和策略。这种整体方法突出了初级医疗保健改革在升级物质资源和人力资本方面的积极影响，但也强调了地理社会不对称以及部门内和部门间缺乏协调的问题。所提出的框架也可作为未来国家和国际初级医疗保健改革的指导方针。
