Managing the Performance of Family Physicians in the Portuguese National Health System

A key aspect of current reforms in Europe is an increased focus on the first line health services, with a central role for the general practitioner/family physician. This paper explores the awareness, among health system managers at various levels, of problems with performance, as well as their perception of what is being done and what could be done to improve it. This study shows that performance management is a poorly developed part of the management armamentarium of public sector managers in the Portuguese NHS. Health services managers appear aware of the need to find mechanisms for performance management at the institutional level, but show little concern for performance management at the individual or sub-institutional level. Moreover, they apparently focus on evaluation of process and structure, and make little or no mention of assessing production of health. [abstract]