Networks of primary and secondary care services: how to organise services so as to promote efficiency and quality in access while reducing costs.

Governments in countries with national health systems have been concerned with how to organise services so as to achieve improvements in efficiency and quality in healthcare delivery, as well as to control costs. In this study, a stochastic discrete event simulation model to study the organisation of primary and secondary care services is proposed. The model was built with reference to the context of the Portuguese NHS, was implemented in the Simul8 software program and was applied to the Portuguese Setúbal healthcare subregion (SHCR). For its application, a database with 2005 production, resource and cost indicators was built to calibrate and validate the applied model. After validation, three different policy scenarios were tested: the first one concerning a 10% increase in demand for primary care services; the second considering a shift between specialists and generalist physicians; and a third regarding restructuring of primary care services. Results show that although the current system is not prepared to cope with a rise in demand, the other scenarios indicate that there is room for primary care reforms to increase the system's efficiency and accessibility, while lowering total costs.