Abstract
BackgroundThe WHO identified the importance of macro-socioeconomic determinants and political context as interlinked key factors affecting healthcare quality and health equity. As a response to the recent economic and financial crisis, Portugal approved in 2011 the Economic Adjustment Programme (EAP) to obtain financial assistance from the Troika in order to reduce public debt. This study aims to analyse the impact of the economic crisis and the EAP on perinatal healthcare quality for very preterm (VPT) and/or very low birth weight (VLBW) infants, as perceived by healthcare professionals and experts, within the health administrative regions of the two major metropolitan areas in Portugal.MethodsA qualitative approach was applied to receive an in-depth understanding and accomplish perspective variability. A purposive sampling technique was used. Semi-structured interviews were conducted with twenty-one healthcare professionals and experts between October 2018–July 2019. Inductive thematic analysis was performed which encompassed a five-step categorization procedure. Data analysis was undertaken by utilizing Nvivo2011 software. Evolved themes were then associated with WHO’s Quality Standards on Maternal and New-born Care. A framework on the impact of macro-socioeconomic determinants on perinatal health care quality was developed.ResultsAlthough participants did not perceive the quality of perinatal care had deteriorated, the analysis of their accounts on work experience revealed that it was indeed adversely modified in all WHO Quality Standards. Health care provision was perceived as detrimental in five main areas: 1) Availability of human resources; 2) Functional referral systems; 3) Competent and motivated human resources; 4) Emotional support; and 5) Essential physical resources available. Policy reforms by the EAP resulted in reduced timeliness of care, increased waiting times, cuts in sequence and duration of consultations, and deficiencies in follow-up care for VPT/VLBW infants and their mothers. The EAP directly influenced working environment of healthcare professionals by causing stress, burnout, work absence, and brain drain.ConclusionAn interrelation between macro-socioeconomic determinants and perinatal health care quality was disclosed. The economic crisis and EAP have adversely modified equitable perinatal health care quality for VPT/VLBW infants and their mothers. Our findings underlined the negative impact of austerity policies on vulnerable populations.
Highlights
Introduction of clinical guidelines4.6 Compulsory electronic-prescription for consistent monitoring evaluation and reportingHealthcare cost reduction5.1 Fundamental revision and adjustment of accompanying exemption rules for healthcare payment5.2 Reduction in tax allowances for healthcare expenditure by two thirds, including private insurance expenses5.3 Revision in provision and purchasing procedures to accomplish savings by centralizing procurement5.4 Cuts in non-emergency transportation to healthcare facilitiesBased on: European Commission. (2011)
Results: participants did not perceive the quality of perinatal care had deteriorated, the analysis of their accounts on work experience revealed that it was adversely modified in all World Health Organization (WHO) Quality Standards
Policy reforms by the Economic Adjustment Programme (EAP) resulted in reduced timeliness of care, increased waiting times, cuts in sequence and duration of consultations, and deficiencies in follow-up care for very preterm (VPT)/very low birth weight (VLBW) infants and their mothers
Summary
Introduction of clinical guidelines4.6 Compulsory electronic-prescription for consistent monitoring evaluation and reportingHealthcare cost reduction5.1 Fundamental revision and adjustment of accompanying exemption rules for healthcare payment5.2 Reduction in tax allowances for healthcare expenditure by two thirds, including private insurance expenses5.3 Revision in provision and purchasing procedures to accomplish savings by centralizing procurement (i.e., reduction in transaction costs)5.4 Cuts in non-emergency transportation to healthcare facilitiesBased on: European Commission. (2011). The economic adjustment programme for Portugal no transcript was returned to participants. As a response to the recent economic and financial crisis, Portugal approved in 2011 the Economic Adjustment Programme (EAP) to obtain financial assistance from the Troika in order to reduce public debt. This study aims to analyse the impact of the economic crisis and the EAP on perinatal healthcare quality for very preterm (VPT) and/or very low birth weight (VLBW) infants, as perceived by healthcare professionals and experts, within the health administrative regions of the two major metropolitan areas in Portugal. Preterm birth is defined as being born before 37 completed weeks of gestational age (GA). Very preterm infants (VPT) are born with less than 32 completed weeks of GA, which commonly signifies to be born with a low (≤2500 g) or very low birth weight (VLBW) (≤1500 g) [1]
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