Open Access Research article

Using discrete event simulation to compare the performance of family health unit and primary health care centre organizational models in Portugal

André S Fialho1, Mónica D Oliveira2* and Armando B Sá3

Author Affiliations

1 Engineering Systems Division, Massachusetts Institute of Technology, 77 Massachusetts Avenue, 02139 Cambridge, MA, USA

2 CEG-IST, Centre for Management Studies of Instituto Superior Técnico, Technical University of Lisbon, Av. Rovisco Pais, Lisbon 1049-001, Portugal

3 Instituto de Medicina Preventiva, Faculdade de Medicina da Universidade de Lisboa, Av. Prof. Egas Moniz, Lisbon 1649-028, Portugal

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BMC Health Services Research 2011, 11:274  doi:10.1186/1472-6963-11-274

Published: 15 October 2011



Recent reforms in Portugal aimed at strengthening the role of the primary care system, in order to improve the quality of the health care system. Since 2006 new policies aiming to change the organization, incentive structures and funding of the primary health care sector were designed, promoting the evolution of traditional primary health care centres (PHCCs) into a new type of organizational unit - family health units (FHUs). This study aimed to compare performances of PHCC and FHU organizational models and to assess the potential gains from converting PHCCs into FHUs.


Stochastic discrete event simulation models for the two types of organizational models were designed and implemented using Simul8 software. These models were applied to data from nineteen primary care units in three municipalities of the Greater Lisbon area.


The conversion of PHCCs into FHUs seems to have the potential to generate substantial improvements in productivity and accessibility, while not having a significant impact on costs. This conversion might entail a 45% reduction in the average number of days required to obtain a medical appointment and a 7% and 9% increase in the average number of medical and nursing consultations, respectively.


Reorganization of PHCC into FHUs might increase accessibility of patients to services and efficiency in the provision of primary care services.

Family health units; primary care reforms; discrete event simulation; performance indicators; Portugal