Abstract
Contractualization consists in the development and implementation of a documented agreement whereby one party (payer) provides compensation to the other party (provider) in exchange for a set of health services to a targeted population. We describe, through a case study, the history and the process of implementation of primary health care contractualization (since 1992) in Portugal, emphasizing the consolidation and future challenges of the primary healthcare reform started in 2005. This article resorts to a case study to reflect on the results obtained in the Cluster of Health Centers of the Northern West, Regional Administration of Lisbon and Tagus Valley, between 2009 and 2015, following implementation of contractualization. It was found that the incentive-related payments will have to be weighted considering the results obtained, strongly influenced by epidemiological and socioeconomic change.
Highlights
In Portugal, the right to health was only recognized in 1971
Through a case study, the history and the process of implementation of primary health care contractualization in Portugal, emphasizing the consolidation and future challenges of the primary healthcare reform started in 2005
This new way of looking at contractualization was consolidated during the implementation of the third stage of contractualization, with two different moments: in the first, an internal contractualization process occurred, in which the ACeS negotiated the various goals with the functional units; in the second, there was an external contracting process in which the Contractualization Department (CD) contractualized with the Executive Directors of the ACeS, which resulted in the signing of program-agreements
Summary
In Portugal, the right to health was only recognized in 1971. This led to the establishment of first-generation health centers, with the primary concern of integrating multiple institutions with preventive and public health concerns, so far organized vertically. Internal contractualization has a new form of internal relationship, alternating decision-making methodologies, presenting itself as a participatory management model, creating consistency among all the activities of the organization, through an alignment of activities with a strategy, aiming to achieve objectives outlined from an external component, of the existing means and the desired results This new way of looking at contractualization was consolidated during the implementation of the third stage of contractualization, with two different moments: in the first, an internal contractualization process occurred, in which the ACeS negotiated the various goals with the functional units; in the second, there was an external contracting process in which the CDs contractualized with the Executive Directors of the ACeS, which resulted in the signing of program-agreements. The negotiation process between CDs and ACeS culminates in the signing of the annual Program-Agreement
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