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As diferenças regionais na adesão ao regime remuneratório experimental dos médicos de clínica geral até Janeiro de 2000
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Resumo(s)
Este trabalho explora as razões que levaram às diferenças regionais de adesão ao Regime Remuneratório Experimental (RRE) até Janeiro de 2000. Considerou-se «adesão» a apresentação de pré-candidaturas que são declarações de intenção de um grupo de médicos e que inicia um processo de negociação com a administração das condições necessárias ao desenvolvimento de um programa de trabalho. Foram realizadas entrevistas semi-estruturadas a uma amostra criteriosa de informadores chave que no ano de 1999 tiveram responsabilidades na concepção e implementação do RRE. A análise de conteúdo das entrevistas fez-se para as categorias: características do RRE, medidas tomadas para dar conhecimento e esclarecimentos sobre o RRE, lições aprendidas com o processo, remuneração de outras profissões da saúde, expectativas em relação à evolução do RRE, razões apontadas para a diferença regional de adesão. O estudo revela deficiências de comunicação entre os diferentes níveis da administração da saúde, pelas diferentes percepções do projecto que apareciam entre os que o conceberam e os que tinham responsabilidades na sua implementação. Por outro lado, parece ser possível ter responsabilidades de gestão do Serviço Nacional de Saúde e explicitamente ignorar os programas e estratégias nacionais. Os factores apontados para as diferentes adesões regionais são essencialmente de dois tipos: os relacionados com características locais e os relacionados com o empenhamento do nível administrativo da saúde e com a assumpção explicita ou não do RRE como prioridade. Muito provavelmente, as diferentes adesões terão mais relação com a determinação das administrações que com factores locais. Para este projecto a abertura e disponibilidade da parte da administração era fundamental. Parece necessário tornar mais claro o processo pelo qual se determinam prioridades a nível nacional, pensar a forma como são envolvidas as pessoas na definição de projectos
que terão que implementar e como melhorar a comunicação entre os diferentes níveis da administração
da saúde. É essencial desenvolver mecanismos de comprometimento dos gestores do Serviço Nacional de Saúde com as estratégias nacionais, acopladas a mecanismos de responsabilização desses mesmos gestores.
n this paper we explore the reasons leading to differences in adherence to the experimental payment system (EPS) until January 2000. “Adherence” was defined as the forwarding of declarations of intention by a group of doctors starting a negotiation process with the administration on the terms for a work program. Semi-structured interviews to a selected sample of key informants who had a role in the conception and implementation of the EPS were performed. Content analysis of the interviews was made for EPS characteristics, measures taken to disseminate knowledge and information about the EPS, lessons learned in the process, payment of other health professionals, expectations about the evolution of the EPS and reasons for the regional differences in adherence to EPS. This study shows communication deficiencies between the different levels of health administration, because of different perceptions of the project between those who conceived it and those who had implementation responsibilities. It seems it is possible to have management responsibilities in the National Health Service (NHS) explicitly ignore national strategies and programs. Factors indicated for different regional adherence are on the whole of two kinds: relating to local characteristics and related to health administration commitment and the assumption, either explicit or not, of the EPS as a priority. Most probably different adherence levels are more related to administration commitment than to local factors. Openness and availability of the administration to this project was paramount. A clearer process for defining national priorities, how to involve in the definition of projects those who will be responsible for their implementation and improving communication between the different levels of the health administration seem necessary steps. Mechanisms binding NHS managers to national strategies, along with accountability measures, are essential.
n this paper we explore the reasons leading to differences in adherence to the experimental payment system (EPS) until January 2000. “Adherence” was defined as the forwarding of declarations of intention by a group of doctors starting a negotiation process with the administration on the terms for a work program. Semi-structured interviews to a selected sample of key informants who had a role in the conception and implementation of the EPS were performed. Content analysis of the interviews was made for EPS characteristics, measures taken to disseminate knowledge and information about the EPS, lessons learned in the process, payment of other health professionals, expectations about the evolution of the EPS and reasons for the regional differences in adherence to EPS. This study shows communication deficiencies between the different levels of health administration, because of different perceptions of the project between those who conceived it and those who had implementation responsibilities. It seems it is possible to have management responsibilities in the National Health Service (NHS) explicitly ignore national strategies and programs. Factors indicated for different regional adherence are on the whole of two kinds: relating to local characteristics and related to health administration commitment and the assumption, either explicit or not, of the EPS as a priority. Most probably different adherence levels are more related to administration commitment than to local factors. Openness and availability of the administration to this project was paramount. A clearer process for defining national priorities, how to involve in the definition of projects those who will be responsible for their implementation and improving communication between the different levels of the health administration seem necessary steps. Mechanisms binding NHS managers to national strategies, along with accountability measures, are essential.
Descrição
Palavras-chave
Médico de família Sistema de pagamento Satisfação profissional Incentivos Organização e administração Reforma do sistema de saúde
Contexto Educativo
Citação
Revista Portuguesa de Medicina Geral e Familiar, [S.l.], v. 19, n. 3, p. 227-36, Maio 2003
Editora
Associação Portuguesa de Medicina Geral Familiar