Impact of macro-socioeconomic determinants on perinatal healthcare quality for very preterm infants

Abstract

The WHO identified the importance of macro-socioeconomic determinants and the political context as interlinked key factors affecting health equity. The 2008 economic crisis was associated with a significant low-birth-weight increase in Portugal, 2007-2014. The Economic Adjustment Programme (EAP), implemented to economize non-essential health care costs (2011-2014), substantially affected healthcare delivery and occupational environment of Healthcare Professionals (HCPs). This study aims to analyse the impact observed by HCPs of the economic crisis and EAP on equitable quality of perinatal healthcare for very preterm infants in Portugal.

A Qualitative study design with 21 HCPs in clinical settings equally distributed among Portuguese mainland were selected according to their response. Semi-structured interviews were conducted between October 2018-April 2019 until saturation point was achieved. A content analysis was performed using Nvivo2011 software.

Preliminary results on macro-socioeconomic determinants, classified and conceptualized into a three-stage-effect framework, disclosed an interrelation between factors impacting perinatal healthcare quality, according to HCPs. Primary-stage: increase in working hours and patient-ratio per HCPs, cuts in salaries and investment, increasing waiting time and HCPs demotivation. Secondary-stage: burnout, work-absence, time constraints, decreasing quality and consultation availability. Tertiary-stage: HCPs Brain-drain to private sector, double-shifts in public-private sector, increasing inadequacy of transmissivity within sector communication.

The economic crisis and EAP were perceived to have modified equitable perinatal healthcare quality for very preterm infants in Portugal. Increased private-public sector transparency to maximise quality assurance, equal HCP wage distribution to sustain capability, strengthening of social maternity protection strategies to enhance socioeconomic equity in perinatal healthcare, is recommended.