THE BUREAUCRATIC BURDEN IN PRIMARY HEALTH CARE: AN EFFICIENCY PROBLEM?

Abstract

Objective: The aim of this research project (in development) is to characterize the bureaucratic burden on family doctors in Portugal; and their perception of it’s impact on satisfaction, quality and efficiency of health care.

Originality: As life expectancy grows, chronic illness increases health care demand (WHO, 2024). In order to achieve universal health coverage, health system efficiency is a priority concern for policymakers globally (Mbau et al. 2023). Inefficiency in health care can compromise access, quality and equity of provided care (Department of Health & Social Care, 2020). Otherwise, physician dissatisfaction with time spent on related paperwork is increasing internationally (Li et al. 2022). Beyond increasing the workload of professionals, bureaucratic work forces them to focus on activities that are not their main function, reducing the time and quality of care, reducing access, making it difficult to prioritize needs to users and professionals, and generating dissatisfaction and burnout among professionals (Goiana-da-Silva et al. 2025). A professional satisfaction survey have showed the bureaucratic work as one of the main dissatisfaction factors (Santiago et al., 2023). Dissatisfaction, self-efficacy and burnout have consequences in professionals' health and productivity (Melo-Ribeiro et al., 2023; Bernales-Turpo et al., 2022). Considering this overview, and the absence of researches in this topic in Portugal, we considered important to address this problem and its impact on health care.

Methodology: A questionnaire will be applied to a representative sample of family doctors working in the Portuguese National Health Service, to assess the bureaucracy overload and its impact on health care. Snowball will be used to collect responses, share a Google Forms document on social networks and professional groups. The questionnaire will have four parts: the first with questions regarding the bureaucracy’s burden in the daily practice of doctors; the second questioning the impact of it on theis satisfaction, and on health care quality and efficacy; a third, with the Portuguese version of the Maslach Burnout Inventory - Human Services Survey (MBI-HSS); and fourth a request for suggestions to reduce the bureaucratic work in primary health care. The data will be analyzed with Excel, Stata and/or SPSS software.

Practical implications: The data analysis will allow the characterization of the bureaucratic burden among family doctors and a better understanding of their perception of impact on their work satisfaction, quality of care provided and efficiency of primary health care. It will also be characterized levels of professional burnout. Additionally, the professional's suggestions for improvement will be analyzed to develop public policy proposals in this field that may contribute to the health care efficacy and quality.

Research limitations: Validation of the questionnaire can be challenging in a bordering area between medicine and economics. Snowball sampling has limitations, mainly related to the representativeness and generalizability of results. The main disadvantage is selection bias, as the sample is constructed based on references from participants who have already been included, which may not reflect the diversity of the target population, such as the age of respondents, length of experience as specialists, geographic representation, among others. There will be no assessment of the quality or efficiency of health care by an analysis of indicators of the care provided by the responding doctors.