The Alpha Groups and adherence to the experimental Remuneration Scheme

Abstract

In 1996 the Alpha Project began, in the Health Region of Lisboa e Vale do Tejo. It aimed to stimulate professionals initiatives about organizational solutions in order to achieve a better seizing of the existing capacity in the Health Centres from the Portuguese National Health Service, allowing in the future to bring in more resources for the system, according to the actual needs. Following the Alpha groups performance assessment, the General Practitioners Experimental Remuneratory Regimen (ERR) was proposed; simoultaneously efforts were being made to widen this reflection to other health care professions. Aim: To identify the reasons associated with adhesion or non-adhesion of the Alpha groups to the GPs ERR; to describe the course of each group and to collect their testimonies on what they consider lessons that were learned from the groups constitution, functioning and evolution. Population and Methods: Qualitative and descriptive study which included thirteen Alpha groups. Interviews were requested to the contact person from every individual group; three groups refused their participation. A semistructured interview strategy was used, and a content analysis of the answers was performed. Results: Ten groups were studied: four adhered to the ERR, five didnt adhere and one suspended itself before the beginning of the experience. The referred reasons for non-adhesion were the non-applicability of the ERR to all the professionals of the team, the short difference between the salaries in the ERR and in the conventional regimen, the insufficiency of available human resources and the fear of increased administrative work. The evolution to ERR seemed natural to the four Alpha groups that adhered to the new regimen, allowing a legal support to the existing experiences. The innovative model of remuneration, directly related to the performance, and the expectations of seeing its own work assessed and recognized, and of working with a greater level of autonomy were well valued. Conclusions: The Alpha Projects were an innovation in the organization and management of family health care, based on the initiative of the professionals who knew the local specificities. The Alpha groups history shows examples of innovation opportunities with good results which do not depend on legislative instruments. At least to a part of the professionals, the development of positive discrimination or incentives systems in the public health care services is desired. However, these systems should involve all the professionals in the team and evolve, eventually, to individual and groups remuneration components. The studied group of professionals showed good initiative, innovation, devotion and problem-solving skills, which makes necessary the development of assessment strategies, counterparts and recognition of the invested effort, if not the initiative of these professionals for the improvement of the public health care system may be lost.