The effect of commissioning on Portuguese Primary Health Care units' performance: A four-year national analysis

Autores da FMUP

• 

  Altamiro Manuel Rodrigues Da Costa Pereira

  Autor

• José Alberto Da Silva Freitas

  Autor

Participantes de fora da FMUP

• Ramalho, A
• Viana, J
• Hespanhol, A.
• Biscaia, A

Unidades de investigação

• Laboratório Associado RISE- Rede de Investigação em Saúde

  

  Investigador

  Fernando Carlos De Landér Schmitt

• Medicina da Comunidade, Informação e Decisão em Saúde

• RISE-Health

  

  Investigador

  Fernando Carlos De Landér Schmitt

Abstract

Background: 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. Aim: Our article aims to clarify the effect of commissioning on the results achieved by PHC units in Portugal following the implementation of the reform. Results: 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 Sa uacute;de 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 Sa uacute;de Personalizados that were created under the model before the reform and offer a fixed salary), respectively. Conclusion: 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.

Keywords

• Health care reform; Family health; Primary Health Care; Models; Organizational; Commissioning