The 2022 budget reveals particular concerns with three fundamental policy axes: a) qualifying citizens’ access to health care; b) motivate (and secure) health professionals; c) invest mis in the public NHS network.
In the first axis, we have the reinforcement in the creation of more Family Health Units, allowing this model not to be limited to the coast and can also benefit the populations of the interior. It should be noted that these USF should not be seen uncritically, as if their performance were an unquestionable success and the increased remuneration to which professionals are entitled is absolutely justified.
No, the results are far from what would be required, either in terms of population coverage, in response to acute illness, or in the role of “gatekeeper” to control the massive influx to emergency services:
30% of those registered do not go to their hospital. family doctor, the emergency room is still full of simple clinical cases that should be the responsibility of family doctors, only a minority of requests for consultation for the same day are actually attended to.
The second axis is perhaps the most difficult to implement: how to motivate health professionals? The budget pursues various attempts at motivation, some with logic and technical consistency, others little less than disastrous.
The most emblematic, but which is neither quantified nor foreseen in time, is related to full-time professional practice. It is not clear what the government means with the concept, which will have to be defined and densified, in order for us to understand its impact.
The idea of the Medical Association and the unions is that that concept is synonymous with a professional statute of exclusivity, with a free option for each professional and with a remuneration significantly increased compared to the current one. Nothing more wrong and counterproductive. Hopefully the government will quickly clarify what it wants.
On the other hand, the incentive to overtime that the government introduces in article 37 of the budget law proposal is really worrying. It reveals an inability to recruit doctors, cultivates the need for urgent work and promotes the focus of doctors on its performance against salaries that can reach 50% of the base amount, as more and more hours are worked.
Nothing to recommend and that heavily penalizes the serious and consistent work that must be developed on a scheduled basis. There is also a motivational component in the budget related to the opening of competitions for access and promotion in various careers.
It doesn’t come quantified and can be a good intention with little content. The amount planned to promote the adhesion of more doctors to settle in the most deprived areas of the country does not appear quantified either. But I imagine that, unfortunately, and taking into account previous experiences, there won’t be any great surprises here.
The motivation of professionals also involves the organizational figure of the CRI (integrated responsibility centers). They are intermediate management units that call for the joint and integrated work of various specialties, centered on the disease and on the person and not on an atomized view of medicine.
These intermediate structures, although in part already adulterated in the Portuguese way, have the advantage of making areas of clinical intervention in our hospitals autonomous and creating forms of remuneration based on results and not just on salary. The government intends to encourage these structures and professionalize them around the concept of full dedication. We are still very late but it seems to be a good way forward.