title: [Perceptions of primary care physicians in Madrid on the austerity measures in the health care system].
abstract: OBJECTIVE
  To address the current economic crisis, governments have promoted austerity measures that have affected the taxpayer-funded health system. We report the findings of a study exploring the perceptions of primary care physicians in Madrid (Spain) on measures implemented in the Spanish health system.
  
  
  METHODS
  We carried out a qualitative study in two primary health care centres located in two neighbourhoods with unemployment and migrant population rates above the average of those in Madrid. Interviews were conducted with 12 primary health care physicians. Interview data were analysed by using thematic analysis and by adopting some elements of the grounded theory approach.
  
  
  RESULTS
  Two categories were identified: evaluation of austerity measures and evaluation of decision-making in this process. Respondents believed there was a need to promote measures to improve the taxpayer-funded health system, but expressed their disagreement with the measures implemented. They considered that the measures were not evidence-based and responded to the need to decrease public health care expenditure in the short term. Respondents believed that they had not been properly informed about the measures and that there was adequate professional participation in the prioritization, selection and implementation of measures. They considered physician participation to be essential in the decision-making process because physicians have a more patient-centred view and have first-hand knowledge of areas requiring improvement in the system.
  
  
  CONCLUSIONS
  It is essential that public authorities actively involve health care professionals in decision-making processes to ensure the implementation of evidence-based measures with strong professional support, thus maintaining the quality of care.
authors.affiliation: Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal, Madrid, España.
authors.forename: Julio
authors.initials: J
authors.lastname: Heras-Mosteiro
authors.affiliation: Sección Departamental de Enfermería, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España. Electronic address: laura.otero@uam.es.
authors.forename: Laura
authors.initials: L
authors.lastname: Otero-García
authors.affiliation: CIBER de Epidemiología y Salud Pública (CIBERESP), España; Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, España.
authors.forename: Belén
authors.initials: B
authors.lastname: Sanz-Barbero
authors.affiliation: Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal, Madrid, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, España.
authors.forename: Jesús María
authors.initials: JM
authors.lastname: Aranaz-Andrés
mesh_terms: D003695:Delivery of Health Care / Q000191:economics* / Q000331:legislation & jurisprudence; D005260:Female; D015276:Health Care Rationing; D006801:Humans; D008297:Male; D058007:Physicians, Primary Care; D011320:Primary Health Care; D036301:Qualitative Research; D013030:Spain
keywords: Atención primaria; Calidad; Health care systems; Health policy; Investigación cualitativa; Perspectiva profesional; Políticas de salud; Primary care; Qualitative research; Quality of health care; Servicios de salud