Contractualization in primary health care in the Regional Health Administration of Lisbon and Tagus Valley until 2023

The article discusses contractualization in Primary Health Care (PHC), relating what has been contractualized and what has been achieved to answer the question: can contractualization contribute to guaranteeing equity and adequate access to PHC? A case study methodology was used, using data available on the SNS Transparency Portal and data used in external contractualization. Data was collected in December 2023. In the Lisbon and Tagus Valley Health Region, 29.6 percent of people were registered without a family doctor in 2023. One-year appointment usage rates fell progressively (-2.7%) between 2021 and 2023. As for cancer screening, in the case of colon and rectum screening, only 34.4% of those contractualized were performed in 2021 and 28.9% in 2022. Regarding the Overall Performance Index, the variation intervals between the negotiated proposals and those obtained were above 20 points. Drug therapy prescription in Diabetes Mellitus was analyzed, and no ACES achieved the expected values. We concluded that contractualization has not helped improve access and equity, as a gap between the situational or local strategic planning phases seems evident.