Table 1.

Summary of policy change in Portuguese hospitals

Policy change	Examples
Decentralization of competencies	• Purchaser/provider split: public organizations turned into public corporations and afterwards into public enterprises • Flexible models of human resources management (individual labour contracts; appraisal system; culture of meritocracy) • Accounts controlled by a single supervisor (board of directors) appointed by the Ministry of Health • Directors of departments appointed among the most qualified doctors by the hospital’s board of directors
Financing control	• Performance-based funding (DRGs) • Non-compliance with contracted activity penalizes the following year’s budget • Budget control tools at the organizational and ward levels • Evaluation in accordance with quantitative criteria
Managerial control	• Evidence-based procedures (cost/benefit ratio) • Clinical guidelines (for monitoring and assessing incentives and sanctions) • Administrative approval of medical decisions • Opening of management positions in departments (middle-level structures of control) • Hiring of general managers
Deregulation of the labour market	• Rise in individual contracts, short-term contracts, and service provision • Freezing of professional careers • Increase in wage variation within health professions
Quality and safety controls	• Monitoring technological tools • Quality reports • Internal and external audits and benchmarking • Procedures to monitor malpractice