Abstract

ALMEIDA, Lúcio Meneses de. Public health services and the health care system. Rev. Port. Sau. Pub. [online]. 2010, vol.28, n.1, pp.79-92. ISSN 0870-9025.

Public health, as a social endeavor that aims to improve the health and well-being of communities and populations (Rychetnik et al., 2004), faces new challenges that arise from the ageing of the populations, the technological innovation of the health sector and the increasing demand for health care services. Because of the importance of health care services as determinants of health, the sustainability of the health care system is a major issue to be addressed in order to ensure a favorable trend of the health status for most of the countries. Among the strategies that have been suggested, we describe the CLINECS-based clinical practice (Portlzolt and Kaplan, 2006) and, within a community-based approach, the «chronic care model» (Wagner et al., 2001) - which consists on the integration of broader community resources into the chronic diseases planning and management processes. Public health has been lacking a useful conceptual framework (Turnock, 2004). The national reorganization of public health services in Portugal impels towards the discussion of a national public health conceptual framework. The framework to be adopted by the public health community should address the necessary balance between comprehensiveness and comprehensibility, in order to promote its acceptance by the public health stakeholders - including the general public. The author describes the model proposed by Donabedian regarding the health care quality («Donabedian’s triad»). The Donabedian’s triad is an important tool for the understanding of the several dimensions of public health (Turnock, 2004) particularly, as far as the functioning of the public health services is concerned. We discuss the role of the public health services according to a systemic conceptual framework and their positioning within the national health system in Portugal. Public health doctors must act as «health system’s doctors» and ensure the «surveillance» of the health system («systemic surveillance») in order to promote the equity, effectiveness and efficiency of the health care sector.

Keywords : public health; health care system; health care services organization; chronic diseases; health empowerment.

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