[Self management or managerial autonomy. SESPAS report, 2012].
Western countries with strong primary care systems organize their health services around this healthcare modality, which serves as a gateway to the system and is characterized by multidisciplinary teamwork, management transferred to the teams and a broad services portfolio. The contractual relationship between professionals and the public health system is a useful tool to modulate the efficiency of services and their ability to meet the expectations of citizens and professionals. Some countries choose to contract professionals directly, either individually or through a professional organization, an option known as a self-management system. Others opt to contract public or private entities, which in turn recruit health professionals as employees. In the latter countries, the concept of management decentralization and managerial autonomy has arisen. In Spain, only Catalonia has enabled professional entities to be hired to provide public health services, through commercial formulas, i.e. in a competitive market relationship. This relationship allows the use of corporate governance mechanisms that are not subject to public control through state intervention. The other forms of management promoted in Spain to avoid the controls of state intervention - foundations or associations - have been unsuccessful, except in the autonomous region of Valencia and some models in the autonomous region of Madrid.
Equip d'Assistència Primària Vic SLP, Vic, Barcelona, España. albert.ledesma.castelltort@gmail.com
Albert
A
Ledesma Castelltort
D032982:Contracts; D004465:Economic Competition; D005194:Family Practice / Q000191:economics / Q000331:legislation & jurisprudence / Q000458:organization & administration; D033161:Government Regulation; D006282:Health Personnel / Q000458:organization & administration; D006801:Humans; D017146:Models, Organizational; D009313:National Health Programs / Q000191:economics / Q000458:organization & administration*; D010560:Personnel Selection; D011057:Politics; D011320:Primary Health Care / Q000191:economics / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D017009:Professional Autonomy; D011364:Professional Practice / Q000331:legislation & jurisprudence / Q000458:organization & administration; D011635:Public Health Administration; D012955:Societies, Medical / Q000458:organization & administration; D013030:Spain