Fatores determinantes da não concretização em 20 anos, da autonomia de gestão administrativa e financeira nos cuidados de saúde primários (CSP) em Portugal : estudo de percepções de informadores-chave

Dissertação de Mestrado em Administração PúblicaIntrodução – A Autonomia administrativa e financeira dos cuidados de saúde primários (CSP) está consagrada em vários diplomas legais, desde 1993, mas nunca foi implementada. O DL n.º 28/2008 de 22 de fevereiro, criou Agrupamentos de Centros de Saúde (ACeS), apenas com autonomia administrativa. Objetivos – Identificar fatores condicionantes da atribuição de entidade própria com autonomia administrativa e financeira aos ACeS e razões para a não concretização. Saber se os profissionais mais envolvidos nas reformas ocorridas ao longo destes anos, atribuem importância e se consideram ser vantajoso para este nível de cuidados, a autonomia administrativa e financeira. Métodos - Estudo qualitativo – realizadas 15 entrevistas semiestruturadas, baseadas em nove perguntas, a antigos e atuais decisores políticos (ex-ministros ou secretários de estado) e dirigentes de administrações regionais de saúde (ARS) ou ACeS. Resultados – As respostas corresponderam a 30.193 palavras. Foi feita análise do seu conteúdo. Obtiveram-se 76 categorias e 220 subcategorias. O enquadramento da análise foi feito tendo em conta as teorias da Gestão Pública, nomeadamente a “New Public Management”. Discussão e conclusões – A diversidade de perspetivas recolhidas, algumas delas antagónicas entre si, permitiram propor um quadro interpretativo multifacetado, sistematizável em torno de fatores explicativos que se enunciam no final do estudo.Introduction - The administrative and financial autonomy of primary health care (PHC) is enshrined in legislation since 1993, but was never implemented. The DL n.º. 28/2008 of 22 February, created groupings of health centers (ACeS), with administrative autonomy. Objectives - To identify determining factors for assigning own entity with administrative and financial autonomy to ACeS and reasons for non-completion. To know if professionals involved in the reforms that have occurred over the years attribute importance and consider administrative and financial autonomy to be advantageous for this level of health care. Methods - Qualitative study - 15 semi-structured interviews were conducted, based on nine questions, to former and current politicians (former ministers or secretaries of state) makers and leaders of regional health care administrations (ARS) or ACeS. Results - The answers corresponded to 30.193 words. Analysis of its contents was made. 76 categories and 200 subcategories were obtained. The framework of the analysis has been done taking into account the theories of Public Management, including the "New Public Management". Discussion and conclusions - The diversity of perspectives gathered, some of them contradicting one another, allowed to propose a multifaceted interpretive framework, systematical around explanatory factors that are set out at the end of the study.Introduction - The administrative and financial autonomy of primary health care (PHC) is enshrined in legislation since 1993, but was never implemented. The DL n.º. 28/2008 of 22 February, created groupings of health centers (ACeS), with administrative autonomy. Objectives - To identify determining factors for assigning own entity with administrative and financial autonomy to ACeS and reasons for non-completion. To know if professionals involved in the reforms that have occurred over the years attribute importance and consider administrative and financial autonomy to be advantageous for this level of health care. Methods - Qualitative study - 15 semi-structured interviews were conducted, based on nine questions, to former and current politicians (former ministers or secretaries of state) makers and leaders of regional health care administrations (ARS) or ACeS. Results - The answers corresponded to 30.193 words. Analysis of its contents was made. 76 categories and 200 subcategories were obtained. The framework of the analysis has been done taking into account the theories of Public Management, including the "New Public Management". Discussion and conclusions - The diversity of perspectives gathered, some of them contradicting one another, allowed to propose a multifaceted interpretive framework, systematical around explanatory factors that are set out at the end of the study