Health Systems and Policies

Coordination: Catarina Delaunay

Presentation and objectives:

This subgroup seeks to cover the different frameworks of strategic policies that encompass the definition, planning, regulation, implementation, and evaluation of health systems. In this context, attention must be paid to the various stakeholders involved in the process, whether the state/policy makers (national and/or regional governmental agencies and organizations), health service providers (public, private, cooperative, along with professional associations and/or unions, and healthcare networks), and citizens (patient associations, Non-Governmental Organizations, representatives of civil society, etc.).

This work subgroup intends to analyze and discuss the objectives of current health systems and the orientation of public policies and legislation necessary for their implementation. This research takes into account a set of principles that highlight equity and universal access to health care, the quality and safety of the care provided to the population, as well as the sustainability, efficiency, and accountability of providers.

The ultimate objective of this workgroup is, therefore, to document the strengths, gaps, and challenges of health systems, from a comparative perspective at an international level by benchmarking the Portuguese case.

The production of multi and interdisciplinary knowledge will be preferred, along with the promotion of scientific debate based on collaborative work, to produce outputs such as the submission of articles in indexed international journals and project applications for funding. national and European, as well as dissemination of the work developed in scientific events.

Research topics:

The research topics within this subgroup can be divided into two main areas:

1) Governance

- Governance models of the health system(s), with a focus on organizational structure and political articulation at each level.

- The specificities of the Portuguese case, compared to other countries, in terms of processes and actors involved in the local/national design/formalization of public health governance policies and models, including the role of citizens.

- The changes and impacts of the implementation of the New Public Management (NGP) in the models of public governance and organizational management, and the specificities depending on the different contexts (hospitals, primary health care).

- The role of new information technologies and the so-called digital transformation in health in Portugal, compared to other national contexts.

2) Regulation

- The health regulation strategies, models, and mechanisms developed in Portugal, in close correlation with public policies in the sector; principles of technical, operational, and economic efficiency versus ethical-normative and social principles.

- The main difficulties and current challenges to health regulation, namely in terms of evaluation and monitoring of the performance of health services and systems, access to care, and quality of services provided.

- The sustainability of health systems in their different aspects: economic (technical, financial, and political dimensions), ethical-social (responsiveness, decentralization/proximity, right to health), and environmental (reduction of ecological footprint and waste production, avoidance of waste).

- The impact of global crises and emergencies (e.g. the COVID-19 pandemic, migratory flows of refugees), on the resilience of health systems and the definition of public policies suited to emerging needs (new pathologies, new target groups).

Coordination: José Carlos Pinto da Costa

Presentation, objectives and research topics:

The researchers of the Saúde Digital group propose to listen to the positions of institutions and the experiences of agents from the four helices of innovation (governance, academia, industry and society) along the process of implementing digital health in Portugal and to analyse how the differences that eventually arise among those positions are managed in order to produce discursive coalitions and collaborative practices. Starting from here, the group seeks to obtain a comprehensive picture of the processes of involvement of the different stakeholders on the implementation of digital health in terms of policies (conceptualization and design of models and implementation and regulation strategies), practices (management of resources and local services of health and therapeutic interactions) and access (adoption of help-seeking behaviours and designing of new itineraries of using the health care services).

For the development of the work, the depth and diversity of experiences and skills of the members of the group is counted on. The team remains open and receptive to welcoming new elements from different scientific backgrounds and areas, including doctoral students and post-doctorate researchers. This expansion will serve to expand the existing critical mass to respond to calls for highly competitive contests and projects in the near future and to possible expressions of interest heading to the formation of research and development consortia in the field of digital health implementation in Portugal and abroad.

Coordenação: João Paulo Magalhães

Context

Health services management and governance research are a fundamental asset for an organization, including the development of theories, models, instruments and tools, in order to improve the effectiveness and efficiency of health systems overall. New governance and management models have been adopted, with the aim of improving both the efficiency of processes and the quality of the services provided, taking into account the numerous social, economic and environmental challenges that currently exist. Health services management and governance consist on processes of continuous learning, as health services are highly complex organizations that are part of a vast and diversified network, taking into account their mission and people expectations, the multidisciplinary teamwork, the high degree of technical-scientific specialization, and the range of services provided, including preventive, curative and rehabilitation healthcare services, using advanced technology.

Strategic goals

• Identify the current and future challenges for health services management and governance, focusing on population health
• Generate information and knowledge about governance models, instruments and tools that support quality, effective and efficient health services delivery and be able to meet population and health workforce needs

Research Pilars

1. Access to health – Tools for improve access to healthcare
2. Integrated governance – Components and tools for a multi-level health governance

Coordinator: Sara Vera Jardim

Presentation

The progressive expansion of the European Union's political and legislative intervention in the field of human health has recently supported the expectation of a future European integration built around this domain of governance. The trend observed over the last few decades has been gradual, but has resounded with a bang after the presentation of the proposal for a “European Health Union” (2020).

The principle of territoriality associated with health policy, as prescribed in Base 4, no. 1, of the Basic Law on Health, may require an updated interpretation that contemplates the obvious contribution of European law. The European influence goes beyond the themes traditionally connected with public health, covering, even if not directly, aspects of the management and organization of our health system.

The discussion around the scope and objectives of the “European Health Union” is therefore not just a matter of European policy, but also a debate on the present and future of national health policy. Among others it is a discussion on the hypothesis of a transfer of competences, on the value and scope of the principle of solidarity, on who dictates the rules for preparing and responding to the foreseen health crises and who is responsible for managing the risk during them, but also on who defines the priorities in the health promotion and prevention of (what) diseases, who is responsible for assessing health technologies, ensuring equitable access to timely medicines and medical countermeasures, or protecting shared health data in a “European Health Data Space”.

Faced with an expansionist vocation in an area with a strong political bent, the European Health Union's agenda is not completed. Its future calls for greater tension between the preservation of national sovereignty in matters of health and the search for convergence of the different health systems of the Member States, in favor of greater equity, universal health coverage, but also to assure a stronger and more autonomous European Union in the global context. Europeanization of health policy and governance should be absolutely transparent and be legitimated by a constitutional conformity check.  

Aims:

• Generate knowledge about European health policy and law as relevant aspects in the development of Portuguese health policy and system.
• Promote, at the national level, the discussion on the consequences of the Europeanization of health, with emphasis on the most recent proposal for the creation of a European Health Union
• Submission of an article on European health policy and law, recognizing them as factors in the development of national health policy.

Investigation topics:

1. European Health Union (UES) Framework

1.1 Conceptual framework
1.2 Emergence and development
1.3 Regulatory framework (in view of the EU's constituent treaties)
1.4 Distinction from other areas of European health policy

2. Reflections of the proposals that constitute the European Health Union in the national health system

2.1 Pharmaceutical strategy for Europe
2.2 Strengthening the competences of European agencies and the new competences of the Health Emergency Preparedness and Response Authority (HERA)
2.3 One Health
2.4 Legal framework applicable to serious cross-border threats to health: proposal for a regulation on serious cross-border threats to health and repealing Decision No. 1082/2013/EU
2.5 Europe’s beating Cancer Plan
2.6 European Health Data Space (EHDS)

3. The Europeanization of the national health policy.

3.1 Characterization of the scope of European integration in the field of health.
3.2 Analysis of the subsidiarity principle and Article 164 of the Treaty on the Functioning of the European Union (TFEU).
3.3 Competence in public health vs. provision of care: hypothesis of a conceptual distinction in crisis in view of the most recent developments and study of causes.
3.4 Transfer or overlap of competences between the national and supranational levels? (Re)centralization? Analysis of the respective legal compliance.
3.5 The role of the solidarity principle in European health policy
3.6 Effects of European health regulation on people's fundamental rights
 

Coordination: Inês Fronteira

Background and objectives

Human resources for health are fundamental to universal health coverage and the achievement of sustainable development goals. Although it is in low-income countries that the largest HRH deficit is found, all countries without exception experience some type of difficulty (e.g., employment, placement, retention, performance).

As such, the health workforce situation needs to be well documented, the reasons for its weaknesses understood and intervention options - what works and what does not - identified.

This group aims to promote an integrated and collaborative vision among academics and health professionals dedicated to the study of human resources for health in its different components. It also aims to expand the knowledge base on human resources for health by sharing research results and potential solutions. Finally, it aims to create a critical mass in human resources for health capable of contributing to the implementation of effective policies in this area.

Research topics:

• Education and professional development
• Funding
• Policies
• Planning, monitoring and analysis
• Leadership
• Partnerships
• Health of health workers
• Information systems on human resources for health