Analysis of the performance of contractualization primary health care indicators in the period 2009-2015 in Lisbon and Tagus Valley

Monteiro, Baltazar Ricardo; Candoso, Fátima; Reis, Magda; Bastos, Sónia

doi:10.1590/1413-81232017223.33242016

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ARTICLE • Ciênc. saúde colet. 22 (3) • Mar 2017 • https://doi.org/10.1590/1413-81232017223.33242016 copy

Analysis of the performance of contractualization primary health care indicators in the period 2009-2015 in Lisbon and Tagus Valley

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Reforms started in 1996 intended that Regional Health Administrations (ARS) should play a relevant role in the process of transforming an integrated model towards a contractual health care model. The essential tool of this transformation would be the Contractualization Agency, established in each ARS. Its role in the new contractualization culture was to negotiate prospective budgets with health care institutions, which included Primary Health Care (PHC). This paper is a longitudinal analysis of the development of a set of nine PHC contractualization indicators in three Health Center Clusters (ACeS) of the Regional Health Administration of Lisbon and Tagus Valley (ARSLVT). We have noticed that the setting of goals, in terms of external contractualization and its monitoring and follow-up are decisive and help health professionals to define trajectories and performance goals. We also recognize the need to revise baseline indicators by developing them into outcome indicators.

Primary Health Care; Contracting; Indicators

Area	From 2009 to 2012		From 2013		Remarks
Area	Indicator	Indicator designation	Indicator	Indicator designation	Remarks
Access	3.15	Overall usage rate for medical consultations	2013.006.V1	Usage rate for medical consultations – 3 years	From 2013 onwards the indicator will consider whether the user has used CSPs over the past 3 years
Care Performance	3.22 d1	Usage rate for family planning medical consultations	2013.052.V1	Proportion of Women of childbearing Age (WCA), with adequate monitoring in Family Planning (FP)	From 2013 the indicator will verify whether the family planning consultations comply with the Family Planning Guidelines
Care Performance	6.12	Proportion of first consultations in life made up to 28 days	2013.014.V1	Proportion of newborns with medical consultation and surveillance up to 28 days of life	The indicator is no longer contractualized (external contractualization), but remains in the base of CSP basic services portfolio
Screening	5.3d1	Proportion of enrolled patients aged 50-74 years with colorectal cancer screening performed	2013.046.V1	Proportion of users [50; 75 [A, with cancer screening CR
	5.2	Proportion of women aged 25-64 years with updated colpocytology (one in 3 years)	2013.045.V1	Proportion of women [25; 60 [A, with colpocytology (3 years)
	5.1M	Proportion of women aged 50-69 with a mammography in the last 2 years	2013.044.V1	Proportion of women [50; 70 [A, with mammography (2 years)
Efficiency	7.6d3	Proportion of consumption of generic drugs in packaging, total packaging of medicines	2013.066.V1	Proportion of drugs billed, which are generic
	7.6d4	Average cost of billed drugs per user	2013.068.V1	Expenditure billed drugs per user (PVP)
	7.7d1	Average cost ofCDTM billed per user	2013.069.V1	Expenditure Complementary Means Diagnostics and Therapeutics billed per user SNS

Area	Indicator designation	2009	2010	2011	2012	2013	2014	2015
Access	Overall usage rate for medical consultations	52,95%	53,08%	54,22%	53,47%	80,32%	79,90%	78,97%
Care Performance	Usage rate for family planning medical consultations	8,89%	12,99%	17,55%	20,40%	20,96%	26,80%	31,50%
Care Performance	Proportion of first consultations in life made up to 28 days	45,42%	50,07%	56,78%	63,62%	68,78%	71,58%	68,75%
Screening	Proportion of enrolled patients aged 50-74 years with colorectal cancer screening performed	4,25%	6,02%	11,17%	16,18%	24,05%	31,20%	36,58%
	Proportion of women aged 25-64 years with updated colpocytology (one in 3 years)	8,27%	13,50%	19,68%	25,07%	33,93%	35,90%	37,67%
	Proportion of women aged 50-69 with a mammography in the last 2 years	14,24%	21,85%	32,10%	39,81%	47,58%	47,20%	49,28%
Efficiency	Proportion of consumption of generic drugs in packaging, total packaging of medicines	21,73%	27,94%	33,47%	38,75%	43,12%	45,90%	46,26%
	Average cost of billed drugs per user	--	197,9 €	174,4 €	154,3 €	142,1 €	149,1 €	138,8 €
	Average cost of CDTM billed per user	77,4 €	76,5 €	65,2 €	54,9 €	55,1 €	55,8 €	54,2 €

		Almada				Almada_seixal

Area	Indicator designation	2009	2010	2011	2012	2013	2014	2015
Access	Overall usage rate for medical consultations	57,36%	56,38%	57,55%	56,92%	81,88%	80,90%	81,73%
Care Performance	Usage rate for family planning medical consultations	19,52%	21,03%	25,01%	26,97%	30,47%	35,50%	41,29%
Care Performance	Proportion of first consultations in life made up to 28 days	66,35%	66,04%	66,98%	71,95%	77,49%	80,43%	79,40%
Screening	Proportion of enrolled patients aged 50-74 years with colorectal cancer screening performed	8,48%	8,27%	16,15%	22,43%	32,05%	43,20%	48,31%
	Proportion of women aged 25-64 years with updated colpocytology (one in 3 years)	18,82%	22,40%	27,58%	30,96%	43,71%	45,00%	47,48%
	Proportion of women aged 50-69 with a mammography in the last 2 years	24,73%	29,21%	38,59%	42,80%	52,38%	52,90%	54,45%
Efficiency	Proportion of consumption of generic drugs in packaging, total packaging of medicines	24,87%	31,80%	37,38%	41,42%	48,02%	51,30%	52,14%
	Average cost of billed drugs per user	--	190,6 €	169,4 €	151,3 €	134,8€	146,3€	129,0 €
	Average cost of CDTM billed per user	76,9 €	75,7 €	67,2 €	56,9 €	55,5 €	55,4 €	50,9 €

Area	Indicator designation	2009	2010	2011	2012	2013	2014	2015
Access	Overall usage rate for medical consultations	47,53%	56,10%	64,54%	65,53%	89,42%	89,00%	88,96%
Care Performance	Usage rate for family planning medical consultations	9,28%	15,53%	20,47%	26,07%	33,14%	40,70%	46,20%
Care Performance	Proportion of first consultations in life made up to 28 days	47,16%	56,15%	80,06%	84,53%	84,15%	86,16%	86,70%
Screening	Proportion of enrolled patients aged 50-74 years with colorectal cancer screening performed	1,83%	3,34%	8,83%	13,06%	19,04%	28,70%	37,59%
	Proportion of women aged 25-64 years with updated colpocytology (one in 3 years)	5,53%	15,70%	23,54%	32,65%	43,80%	48,50%	51,74%
	Proportion of women aged 50-69 with a mammography in the last 2 years	11,07%	27,03%	36,09%	51,03%	60,41%	63,20%	63,06%
Efficiency	Proportion of consumption of generic drugs in packaging, total packaging of medicines	21,36%	25,91%	32,20%	41,00%	45,48%	48,30%	48,10%
	Average cost of billed drugs per user	...	254,1 €	195,2 €	156,0 €	146,8 €	141,5 €	141,5 €
	Average cost of CDTM billed per user	94,4 €	80,1 €	56,9 €	44,7 €	44,1 €	44,3 €	46,4 €

Area	Indicator designation	2009	2010	2011	2012	2013	2014	2015
Access	Overall usage rate for medical consultations	47,59%	45,98%	46,58%	46,28%	78,88%	76,60%	76,83%
Care Performance	Usage rate for family planning medical consultations	5,08%	8,96%	14,03%	16,57%	21,03%	28,70%	33,54%
Care Performance	Proportion of first consultations in life made up to 28 days	49,35%	54,51%	61,39%	69,02%	75,94%	74,62%	72,76%
Screening	Proportion of enrolled patients aged 50-74 years with colorectal cancer screening performed	1,36%	4,02%	9,52%	16,02%	31,51%	41,50%	43,92%
	Proportion of women aged 25-64 years with updated colpocytology (one in 3 years)	3,31%	7,65%	13,84%	19,46%	33,19%	37,40%	39,73%
	Proportion of women aged 50-69 with a mammography in the last 2 years	6,99%	16,86%	28,48%	36,16%	49,63%	51,50%	49,86%
Efficiency	Proportion of consumption of generic drugs in packaging, total packaging of medicines	22,81%	29,17%	34,07%	39,49%	43,66%	47,30%	47,99%
	Average cost of billed drugs per user		196,8 €	168,3 €	148,3 €	136,9 €	142,2 €	131,6 €
	Average cost of CDTM billed per user	76,6 €	81,9 €	68,6 €	57,6 €	58,8 €	56,7 €	57,4 €

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[1] Collaborations

BR Monteiro was responsible for data collection, writing, critical review and version to be published; F Candoso, for data analysis and paper’s critical review; M Reis, for data collection and interpretation; and S Bastos, for data analysis and interpretation.