文章基本信息

标题：The effects of austerity measures on quality of healthcare services: a national survey of physicians in the public and private sectors in Portugal
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作者：Tiago Correia ; Graça Carapinheiro ; Helena Carvalho 等
期刊名称：Human Resources for Health
印刷版ISSN：1478-4491
电子版ISSN：1478-4491
出版年度：2017
卷号：15
期号：1
页码：82
DOI：10.1186/s12960-017-0256-6
语种：English
出版社：BioMed Central
摘要：The European Union member countries reacted differently to the 2008 economic and financial crisis. However, few countries have monitored the outcomes of their policy responses, and there is therefore little evidence as to whether or not savings undermined the performance of health systems. We discuss the situation in Portugal, where a financial adjustment program was implemented between 2011 and 2014, and explore the views of health workers on the effects of austerity measures on quality of care delivery. A nationwide survey of physicians’ experiences was conducted in 2013–2014 (n = 3442). We used a two-step model to compare public and private services and look at the possible moderating effects of the physicians’ specialty and years of practice. Our data analysis included descriptive statistics, the independent t test, analysis of variance (ANOVA), multivariate logistic regression, General Linear Model Univariate Analysis, non-parametric methods (bootstrap), and post hoc probing. Mainly in the public sector, the policy goal of maintaining quality of care was undermined by a lack of resources, the deterioration in medical residency conditions, and to a lesser extent, greater administrative interference in clinical decision-making. Differences in public and private services showed that the effects of the austerity measures were not the same throughout the health system. Our results also showed that physicians with similar years of practice and in the same medical specialty did not necessarily experience the same pressures. The debate on the effects of austerity measures should focus more closely on health workers’ concrete experiences, as they demonstrate the non-linearity between policy setting and expected outcomes. We also suggest that it is necessary to explore the interplay between lower quality and the undermining of trust relationships in health.
关键词：Portugal ; Economic crisis ; Adjustment programs ; Austerity measures ; Quality of care ; Trust