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Abstract(s)
Introdução: O acesso universal a cuidados de saúde apenas pode ser alcançado se for garantido
que, a cada momento, estão disponíveis todos os recursos necessários, o que apenas é possível
com um adequado planeamento. Com base no estudo de modelos semelhantes de outros países,
analisou-se, em diferentes cenários, a adequabilidade futura do número global de médicos no
Serviço Nacional de Saúde português; refletiu-se, numa perspetiva económica, acerca do
impacto da variação do número de médicos; e analisou-se a problemática da distribuição e
retenção, condicionantes de um planeamento adequado.
Métodos: No Modelo da Oferta projetou-se o número de médicos com base nas estimativas de
entradas no Internato Médico e saídas por aposentação, rescisão de contrato e morte. Num
Cenário Base, assumiu-se a manutenção do atual número de rescisão de contrato, num Cenário
Otimista metade deste valor e no Cenário de Máximo Potencial a ausência de rescisões. Foram
considerados dois Modelos para estimar as Necessidades. No Modelo de Benchmarking foi
considerado o rácio médico-habitante médico dos países da OCDE como o número ideal de
médicos atualmente. No Modelo do Diferencial Estimado assumiu-se, em dois cenários
distintos, um défice atual de 5% e 10%. Em ambos os modelos o número de médicos considerado
desejável atualmente foi projetado no tempo com base na evolução populacional prevista.
Resultados: Quando considerado o Cenário Base da Oferta verifica-se, em 2030, um número
expectável de 29.811 médicos, aproximadamente 111% do inicial. Tal projeção é insuficiente
para igualar a projeção de necessidades com base no Modelo de Benchmarking em qualquer
cenário considerado, sendo, no entanto, suficiente para cobrir as projeções de um atual défice
de 10% em 3 de 4 cenários do Modelo do Diferencial Estimado. Quando considerado o Cenário
Otimista da Oferta verifica-se, em 2030, um número expectável de 34.449 médicos,
aproximadamente 128% do inicial. Tal projeção excede as necessidades no Modelo do
Diferencial Estimado em todos os 8 cenários considerados e no Modelo de Benchmarking em 3
dos 4 cenários.
Conclusões: Apesar da diminuição populacional, o fenómeno de envelhecimento poderá, ainda
que de forma modesta, aumentar as necessidades quantitativas de médicos. Contudo, Portugal
tem instalada uma capacidade formativa para, globalmente, gerar um número de especialistas
suficiente para exceder as necessidades em todos os cenários considerados. Mesmo mantendo
a proporção de rescisões anuais atual, Portugal disporá em 2030 de médicos suficientes no
serviço público para cobrir as necessidades previsíveis, considerando um défice estimado atual
de 5-10% destes profissionais.
Introduction: Universal health coverage can only be achieved if one guarantees that, at a certain moment in time, all required resources are available, which is not possible without proper planning. Based upon the analysis of equivalent models in foreign countries, and using different scenarios, the future suitability of the number of physicians in the Portuguese National Health System was assessed; an analysis, from an economic perspective, of the impact of alterations in the number of physicians was made; as well as an analysis of the problematic of distribution and retention, as components of proper planning. Methods: In the Model of Supply the number of physicians was projected based on the expected inputs in training and outputs from retirement, contract termination and deaths. In a Baseline Scenario the maintenance of the current number of contract terminations was assumed, in an Optimistic Scenario half of that number was considered and in a Maximum Potential Scenario no contract terminations were considered. Two different Models were used to estimate the Needs. In the Benchmarking Model, the physician per capita ratio of the OCDE countries was taken as a reference. In the Estimated Differential Model a current deficit of 5% and 10% of physicians was considered, in two different scenarios. In both Models the number of physicians considered desirable was projected on the forecasted population evolution. Results: When we look at the Baseline Scenario of Supply, we can verify an expectable number of 29,811 physicians by 2030, approximately 111% of today. Such projection is insufficient to match the projections of needs in every scenario of the Benchmarking Model, but sufficient to match the projections of a current estimated deficit of 10% in 3 out of 4 scenarios in the Estimated Differential Model. When we look at the Optimistic Scenario of Supply, we can verify an expectable number of 34,449 physicians by 2030, approximately 128% of today. Such projection exceeds the needs in all eight scenarios of the Estimated Differential Model, as well as in 3 out of 4 scenarios of the Benchmarking Model. Conclusions: Despite the population reduction, the ageing phenomenon may, even if in a modest way, increase the necessity of the number of physicians. However, Portugal has a training capacity installed capable of exceeding the specialists needs in every scenario considered. Even if the current number of contract terminations is sustained, Portugal will have enough physicians by 2030 to cover the projected needs, when a deficit of 5-10% of these professionals is considered.
Introduction: Universal health coverage can only be achieved if one guarantees that, at a certain moment in time, all required resources are available, which is not possible without proper planning. Based upon the analysis of equivalent models in foreign countries, and using different scenarios, the future suitability of the number of physicians in the Portuguese National Health System was assessed; an analysis, from an economic perspective, of the impact of alterations in the number of physicians was made; as well as an analysis of the problematic of distribution and retention, as components of proper planning. Methods: In the Model of Supply the number of physicians was projected based on the expected inputs in training and outputs from retirement, contract termination and deaths. In a Baseline Scenario the maintenance of the current number of contract terminations was assumed, in an Optimistic Scenario half of that number was considered and in a Maximum Potential Scenario no contract terminations were considered. Two different Models were used to estimate the Needs. In the Benchmarking Model, the physician per capita ratio of the OCDE countries was taken as a reference. In the Estimated Differential Model a current deficit of 5% and 10% of physicians was considered, in two different scenarios. In both Models the number of physicians considered desirable was projected on the forecasted population evolution. Results: When we look at the Baseline Scenario of Supply, we can verify an expectable number of 29,811 physicians by 2030, approximately 111% of today. Such projection is insufficient to match the projections of needs in every scenario of the Benchmarking Model, but sufficient to match the projections of a current estimated deficit of 10% in 3 out of 4 scenarios in the Estimated Differential Model. When we look at the Optimistic Scenario of Supply, we can verify an expectable number of 34,449 physicians by 2030, approximately 128% of today. Such projection exceeds the needs in all eight scenarios of the Estimated Differential Model, as well as in 3 out of 4 scenarios of the Benchmarking Model. Conclusions: Despite the population reduction, the ageing phenomenon may, even if in a modest way, increase the necessity of the number of physicians. However, Portugal has a training capacity installed capable of exceeding the specialists needs in every scenario considered. Even if the current number of contract terminations is sustained, Portugal will have enough physicians by 2030 to cover the projected needs, when a deficit of 5-10% of these professionals is considered.
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Keywords
Acesso Modelos de Oferta e Necessidades Planeamento Recursos Humanos Sistema de Saúde