{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T11:04:48Z","timestamp":1771671888564,"version":"3.50.1"},"reference-count":32,"publisher":"FapUNIFESP (SciELO)","issue":"suppl 2","license":[{"start":{"date-parts":[[2019,1,1]],"date-time":"2019-01-01T00:00:00Z","timestamp":1546300800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2019,1,1]],"date-time":"2019-01-01T00:00:00Z","timestamp":1546300800000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2019,1,1]],"date-time":"2019-01-01T00:00:00Z","timestamp":1546300800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cad. Sa\u00fade P\u00fablica"],"abstract":"<jats:p>Resumo: Com o intuito de reformar a aten\u00e7\u00e3o prim\u00e1ria \u00e0 sa\u00fade (APS), o Minist\u00e9rio da Sa\u00fade planejou uma mudan\u00e7a que teve o seu avan\u00e7o no per\u00edodo entre 2005 e 2006, e que se desenvolve at\u00e9 aos nossos dias. O objetivo deste artigo \u00e9 enquadrar a reforma da APS em Portugal por diferentes fases de desenvolvimento, utilizando o modelo de fluxos m\u00faltiplos de Kingdon para refletir sobre a evolu\u00e7\u00e3o do processo reformador e o seu futuro, na perspetiva do processo que busca alcan\u00e7ar o acesso universal \u00e0 sa\u00fade. Como metodologia de trabalho, utiliza-se o estudo documental e de caso, de orienta\u00e7\u00e3o qualitativa e com dimens\u00f5es avaliativas. O estudo baseou-se em material publicado, nacional e internacionalmente, sobre a APS em Portugal. O modelo de fluxos m\u00faltiplos de Kingdon \u00e9 utilizado para explicar o desenvolvimento concreto e contextual das pol\u00edticas iniciadas durante a reforma da APS. Foram identificadas tr\u00eas fases da reforma, cada uma com dura\u00e7\u00e3o de cerca de 5 anos: na primeira, a partir de 2005, surgiram as unidades de sa\u00fade familiar de constitui\u00e7\u00e3o volunt\u00e1ria. Na segunda fase, iniciada em 2010, houve a consolida\u00e7\u00e3o do modelo. Em uma terceira fase, desde 2015 e que ainda acontece, h\u00e1 o amadurecimento do modelo, aproveitando o final da crise financeira, mas ainda suportando as suas sequelas. Os tr\u00eas ciclos de reforma representam tr\u00eas per\u00edodos distintos de coer\u00eancia da coaliz\u00e3o que o empreendedor pol\u00edtico foi capaz de estabelecer, cujas janelas de oportunidade para a mudan\u00e7a, internamente constru\u00eddas, foram sobejamente influenciadas por fatores externos. Assinala-se a contribui\u00e7\u00e3o que a reforma da APS deu para a melhoria do estado de sa\u00fade da popula\u00e7\u00e3o portuguesa.<\/jats:p>","DOI":"10.1590\/0102-311x00042418","type":"journal-article","created":{"date-parts":[[2019,8,16]],"date-time":"2019-08-16T17:57:08Z","timestamp":1565978228000},"source":"Crossref","is-referenced-by-count":8,"title":["A reforma da aten\u00e7\u00e3o prim\u00e1ria \u00e0 sa\u00fade em Portugal, 2005-2018: o futuro e os desafios da maturidade"],"prefix":"10.1590","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0506-1294","authenticated-orcid":false,"given":"Lu\u00eds Velez","family":"Lap\u00e3o","sequence":"first","affiliation":[{"name":"Universidade Nova de Lisboa,  Portugal; WHO Collaborating Center for Health Workforce Policy and Planning,  Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9007-8949","authenticated-orcid":false,"given":"Lu\u00eds","family":"Pisco","sequence":"additional","affiliation":[{"name":"Minist\u00e9rio da Sa\u00fade,  Portugal; Nova Medical School,  Portugal"}]}],"member":"530","published-online":{"date-parts":[[2019]]},"reference":[{"key":"ref1","series-title":"The World Health Report 2008: primary health care (now more than ever)","year":"2008"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1016\/S0140-6736(17)32465-0","article-title":"Life, death, and disability in 2016","volume":"390","year":"2017","journal-title":"Lancet"},{"key":"ref3","series-title":"People in the EU: who are we and how do we live?","year":"2015"},{"key":"ref4","series-title":"Proje\u00e7\u00f5es de popula\u00e7\u00e3o residente 2012-2060."},{"key":"ref5","first-page":"1","article-title":"Portugal health system review","volume":"19","year":"2017","journal-title":"Health Syst 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