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- Exploring performance assessment and incentive regulation in the context of primary health carePublication . Kalinichenko, Olena; Amado, Carla; Santos, Sérgio Pereira dosThis thesis consists of two research articles. The first article addresses two research questions: (1) what have been the main performance dimensions and measures used for primary care assessment? And (2) to what extent have key stakeholders been involved in primary care assessment? To answer these questions, we developed a conceptual framework that includes three stages of performance assessment (measurement, analysis, and action) and captures four performance dimensions (accessibility, equity, efficiency, and effectiveness). We applied this framework for a systematic review of the 166 empirical articles devoted to performance assessment of primary care providers. The results of the review show that a wide variety of performance measures has been used to assess primary care providers, and also that the four dimensions have mostly been explored separately. Furthermore, the results of the review reveal an insufficient involvement of stakeholders in the performance assessment process, indicating the potentially limited impact of the reviewed research on health care policy and practice. The second article aims two objectives: (1) to develop a DEA methodology for performance assessment of primary care providers in Portugal; and (2) to propose an alternative methodology for P4P contracting based on the DEA assessment results. To achieve the first objective, we modified the standard DEA model to account for the necessary relations between the weights attributed to each performance indicator and domain and to account for the effect of the relevant environmental variables. To achieve the second objective, we combined relative and absolute performance assessments in the elaboration of several bases for reward, and each of these two assessments is proposed to be linked to a system of graduated rewards. For underperforming units, we suggest establishing absolute targets derived from the relevant benchmarks, identified by DEA. We also recommend the creation of a benchmarking programme that will contribute to the dissemination of best practices among the providers.