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

Pereira, António; Ramalho, André; Viana, João; Hespanhol, Alberto; Biscaia, André

doi:10.1016/j.healthpol.2021.02.008

Cited by 4 publications

(6 citation statements)

References 17 publications

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“…The results for PHC indicators used in the commissioning processes were improved [ 17 ], and there was no evidence that the better results exhibited were achieved at the expense of a detrimental healthcare offered to vulnerable populations, but this was not associated with a reduction in healthcare inequalities. The differences in performance among PHC units in different contexts remained the same after the implementation of the commissioning process in 80% of the cases.…”

Section: Discussionmentioning

confidence: 99%

“…In 2005, the Portuguese Government launched a country-wide reform of primary healthcare services, introducing a new type of PHC unit, the family health unit (“USFs”—Unidades de Saúde Familiar). USFs are public, self-managed primary healthcare units formed by a self-selected group of general practitioners (GPs), PHC nurses and administrative staff, with functional and technical autonomy to organize the delivery of health services [ 17 ]. All USFs can access the government’s PHC incentive scheme, which rewards good practices with grants that may be used to fund training and research activities for the PHC teams.…”

Section: Introductionmentioning

confidence: 99%

“…Our analysis of all PHC units in Portugal during the period of 2013–2016 found that, after the 2005 PHC reform, the quality indicators included in the commissioning process improved. This improvement was not associated with a detrimental effect on noncommissioned indicators and there was a general improvement in the quality of PHC services [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

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Healthcare Equity and Commissioning: A Four-Year National Analysis of Portuguese Primary Healthcare Units

Pereira

Biscaia

Calado

et al. 2022

IJERPH

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Equal and adequate access to healthcare is one of the pillars of Portuguese health policy. Despite the controversy over commissioning processes’ contribution to equity in health, this article aims to clarify the relationship between socio-economic factors and the results of primary healthcare (PHC) commissioning indicators through an analysis of four years of data from all PHC units in Portugal. The factor that presents a statistically significant relationship with a greater number of indicators is the organizational model. Since the reform of PHC services in 2005, a new type of unit was introduced: the family health unit (USF). At the time of the study, these units covered 58.1% of the population and achieved better indicator results. In most cases, the evolution of the results achieved by commissioning seems to be similar in different analyzed contexts. Nevertheless, the percentage of patients of a non-Portuguese nationality and the population density were analyzed, and a widening of discrepancies was observed in 23.3% of the cases. The commissioning indicators were statistically related to the studied context factors, and some of these, such as the nurse home visits indicator, are more sensitive to context than others. There is no evidence that the best results were achieved at the expense of worse healthcare being offered to vulnerable populations, and there was no association with a reduction in inequalities in healthcare. It would be valuable if the Portuguese Government could stimulate the increase in the number of working USFs, especially in low-density areas, considering that they can achieve better results with lower costs for medicines and diagnostic tests.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Healthcare Equity and Commissioning: A Four-Year National Analysis of Portuguese Primary Healthcare Units

Pereira

Biscaia

Calado

et al. 2022

IJERPH

Self Cite

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“…Based on the monitoring of goals and indicators, financial resources are allocated to health facilities or paid directly to professionals (Kovacs et al, 2020;Morgan Andrade Lemos et al, 2018). Although this model has become increasingly widespread in several countries in recent decades, studies on P4P programs show that a gap remains regarding their real effect on improving the quality of health services (Diaconu et al, 2021;Luz Pereira et al, 2021;Roland and Guthrie, 2016).…”

Section: Introductionmentioning

confidence: 99%

“…Although this model has become increasingly widespread in several countries in recent decades, studies on P4P programs show that a gap remains regarding their real effect on improving the quality of health services (Diaconu et al. , 2021; Luz Pereira et al. , 2021; Roland and Guthrie, 2016).…”

Section: Introductionmentioning

confidence: 99%

Pay for performance in Brazilian primary health care: quality of work processes, actions and services

Anjos

Scherer

Cantalino

et al. 2023

IJPSM

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PurposeIn 2011, Brazil introduced a national pay-for-performance (P4P) scheme called the National Program for Improving Primary Health Care Access and Quality (PMAQ), rolled out over three cycles and reaching more than 5,000 municipalities and 40,000 family health teams (FHTs). There is little evidence on how the PMAQ was implemented locally and whether this variation in implementation affects performance, particularly, in terms of work process indicators. This study compared different cases of municipal-level PMAQ implementation (bonuses paid or not to FHTs) over the last two program cycles to analyze the quality of the work processes, actions and services of FHTs.Design/methodology/approachThis was a cross-sectional analytical study using secondary data from an external evaluation of the Brazilian PMAQ. In total, 27,500 FHTs participated in the evaluation. They were divided into four clusters based on whether or not municipalities paid bonuses to workers during cycles 2 and 3 of the program (2013–2019). Variables regarding work processes, actions and services were classified as “Quality Assurance – QA” or “Continued Quality Improvement – CQI”, and an individual score was assigned based on the average score of each variable.FindingsThe four clusters displayed an increase in overall QA and CQI scores between the two program cycles; though this increase was small between the set of primary health care teams that received bonuses and those that did not.Originality/valueThis paper contributes to bridging the gap in the scientific literature for evaluative studies on the relationship between direct payment for performance to health professionals and better quality actions and services in low and middle-income countries.

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Understanding primary care transformation and implications for ageing populations and health inequalities: a systematic scoping review of new models of primary health care in OECD countries and China

Henderson,

Donaghy,

Dozier

et al. 2023

BMC Med

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Background Many countries have introduced reforms with the aim of primary care transformation (PCT). Common objectives include meeting service delivery challenges associated with ageing populations and health inequalities. To date, there has been little research comparing PCT internationally. Our aim was to examine PCT and new models of primary care by conducting a systematic scoping review of international literature in order to describe major policy changes including key ‘components’, impacts of new models of care, and barriers and facilitators to PCT implementation. Methods We undertook a systematic scoping review of international literature on PCT in OECD countries and China (published protocol: https://osf.io/2afym). Ovid [MEDLINE/Embase/Global Health], CINAHL Plus, and Global Index Medicus were searched (01/01/10 to 28/08/21). Two reviewers independently screened the titles and abstracts with data extraction by a single reviewer. A narrative synthesis of findings followed. Results A total of 107 studies from 15 countries were included. The most frequently employed component of PCT was the expansion of multidisciplinary teams (MDT) (46% of studies). The most frequently measured outcome was GP views (27%), with < 20% measuring patient views or satisfaction. Only three studies evaluated the effects of PCT on ageing populations and 34 (32%) on health inequalities with ambiguous results. For the latter, PCT involving increased primary care access showed positive impacts whilst no benefits were reported for other components. Analysis of 41 studies citing barriers or facilitators to PCT implementation identified leadership, change, resources, and targets as key themes. Conclusions Countries identified in this review have used a range of approaches to PCT with marked heterogeneity in methods of evaluation and mixed findings on impacts. Only a minority of studies described the impacts of PCT on ageing populations, health inequalities, or from the patient perspective. The facilitators and barriers identified may be useful in planning and evaluating future developments in PCT.

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

Cited by 4 publications

References 17 publications

Healthcare Equity and Commissioning: A Four-Year National Analysis of Portuguese Primary Healthcare Units

Healthcare Equity and Commissioning: A Four-Year National Analysis of Portuguese Primary Healthcare Units

Pay for performance in Brazilian primary health care: quality of work processes, actions and services

Understanding primary care transformation and implications for ageing populations and health inequalities: a systematic scoping review of new models of primary health care in OECD countries and China

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