Preferences for primary care delivery in Portugal

In the past few years there have been substantial changes to the delivery of primary care in many countries as healthcare reforms introduce new models of care. This began in Portugal in 2005 with the on-going reform of the primary healthcare. Although recent reforms have been accompanied by an effort to monitor the users’ satisfaction based on pre-defined attributes and scales, little is known about population preferences on primary healthcare services and its prioritization. This study used a mixed methods approach to elicit the preferences of the general public for primary healthcare services in Portugal. The study developed valid and reliable measures of primary care attributes relevant to Portugal. These were used to develop a discrete choice experiment to examine preferences and priorities among these attributes among a sample of Portuguese patients. Public preferences were compared with the political choices necessitated by fiscal austerity.

Outcome and Translation

The structural reform of primary healthcare delivery in Portugal began in 2005 but political choices necessitated by fiscal austerity mean that the reform is incomplete. We found patients supported publicly provided primary care and were concerned about its future. They wished to keep the core principles of the Portuguese health service, mainly equity and solidarity. Although the reform was designed to improve efficiency and access in primary care delivery it has not substantially improved primary care delivery and has had a negative impact on equity. The incomplete nature of the reforms has led to a three-tiered model of care (patients with a Family Doctor (FD) and Family Health Unit (FHU), patients with a FD and Primary Care Health Unit (PCHU), patients without a FD and PHCU). This raises equity concerns that must be addressed.

HERU researchers involved in this research project: Patrícia Norwood and Verity Watson

External collaborators: P Viega and I Correia (University of Minho, Portugal)


Norwood, P., Watson, V., Viega, P. and Correira, I. (2013) What do patients want from primary care services? Final report, Ministério da Saude, INSA.

Norwood, P., Correia, I., Veiga, P. and Watson, V. (2019) 'Patients’ experiences and preferences for primary care delivery: a focus group analysis', Primary Health Care Research and Development, 20, e106.


Watson, V., Norwood, P., Benesch, P. V. and Correira, I. (2013) 'Population preferences in primary health care in Portugal' [Poster], Associação Portuguese de Economia da Saúde / Portuguese Health Economics Association, Braga, Portugal, 10-12 October 2013.