Regionalização e acesso à saúde nos estados brasileiros: condicionantes históricos e político-institucionais
01 Nov 2012-Ciencia & Saude Coletiva (ABRASCO - Associação Brasileira de Saúde Coletiva)-Vol. 17, Iss: 11, pp 2881-2892
TL;DR: In this article, the authors examined the healthcare regionalization process in the Brazilian states in the period from 2007 to 2010, seeking to identify the conditions that favor or impede this process.
Abstract: This article examines the healthcare regionalization process in the Brazilian states in the period from 2007 to 2010, seeking to identify the conditions that favor or impede this process. Referential analysis of public policies and especially of historical institutionalism was used. Three dimensions sum up the conditioning factors of regionalization: context (historical-structural, political-institutional and conjunctural), directionality (ideology, object, actors, strategies and instruments) and regionalization features (institutionality and governance). The empirical research relied mainly on the analysis of official documents and interviews with key actors in 24 states. Distinct patterns of influence in the states were observed, with regionalization being marked by important gains in institutionality and governance in the period. Nevertheless, inherent difficulties of the contexts prejudice greater advances. There is a pressing need to broaden the territorial focus in government planning and to integrate sectorial policies for medium and long-term regional development in order to empower regionalization and to overcome obstacles to the access to healthcare services in Brazil.
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01 Oct 2018
TL;DR: A sintese identificou um conjunto heterogeneo de autores e enfoques teoricos; objetos de estudo; estrategias de investigacao; and aspectos concernentes ao exercicio da reflexividade na producao do conhecimento as mentioned in this paper.
Abstract: RESUMO O estudo buscou objetivar, por meio de uma revisao integrativa, em âmbito nacional e internacional, realizada entre 2012 e 2017, o conjunto de abordagens teorico-metodologicas para analise politica em saude, analisando tendencias da producao de pesquisas no que se refere a construcao teorico-metodologica. A sintese identificou um conjunto heterogeneo de autores e enfoques teoricos; objetos de estudo; estrategias de investigacao e aspectos concernentes ao exercicio da reflexividade na producao do conhecimento. A maior parte dos trabalhos e oriunda da saude coletiva, apoiada nas teorias de matrizes sociologicas e das ciencias politicas, como estudos sobre a genese de politicas de perspectiva bourdiesiana e estudos embasados no institucionalismo historico. Os estudos empiricos utilizam como estrategia de pesquisa a combinacao de analise documental com entrevista de informantes-chave, em sua maioria. Poucos autores realizam um retorno reflexivo sobre sua postura teorica frente as demais posicoes no interior do espaco de producao da analise politica em saude. O estudo podera subsidiar um debate que permita analisar a adequacao, a pertinencia e o alcance das abordagens como forma de fortalecer a analise politica em saude, considerada recente no Brasil, cujo potencial de dialogo teorico precisa ser estabelecido entre as distintas tradicoes.
16 citations
TL;DR: In this article, a study of 6.624 idosos brasileiros, with the goal of avaliar o acesso aos servicos de saude by meio da falta de accesso e descricao da trajetoria do uso em internacao, pronto-socorro, and consulta medica.
Abstract: Resumo O envelhecimento populacional e um fenomeno atual e demanda reconfiguracao e ampliacao do acesso aos servicos de saude para a populacao idosa. Estudo transversal, com amostra representativa de 6.624 idosos brasileiros, que teve como objetivo avaliar o acesso aos servicos de saude por meio da falta de acesso e da descricao da trajetoria do uso em internacao, pronto-socorro e consulta medica. As variaveis foram analisadas segundo natureza do financiamento (SUS, convenio e desembolso direto). A prevalencia de falta de acesso foi 2,5% (IC95% 1,6; 4,0) na internacao, 2,1% em pronto-socorro (IC95% 1,4; 3,1), e 0,6% (IC95% 0,3; 0,9) no atendimento medico. O SUS foi responsavel pela maioria dos atendimentos. Aspectos positivos do SUS foram maior numero de atendimentos medicos realizados na cidade de residencia e menor frequencia de dinheiro gasto no deslocamento. O privado se destacou pela baixa frequencia de tempo de espera longo e maior frequencia de encaminhamentos para consulta de revisao apos internacao. Os achados reforcam a importância do SUS na promocao da equidade e universalidade apesar das deficiencias existentes. Tanto no sistema publico quanto no privado faz-se necessario articulacao dos niveis de atencao na perspectiva da integralidade no cuidado ao idoso.
13 citations
TL;DR: A Pesquisa qualitativa desenvolvida by meio de grupos operativos com 55 trabalhadores das equipes gestores de MPP da macrorregiao norte do Parana as discussed by the authors was realizada analise compreensiva e interpretativa utilizando a Teoria do Jogo Social como referencial teorico.
Abstract: Resumo O processo de descentralizacao exerce forte impacto nas financas dos Municipios de Pequeno Porte (MPP) e estes sao o ente mais vulneravel da federacao. Objetivou-se analisar os principais problemas e as estrategias de gestao utilizadas pelos MPP para enfrentar as desigualdades decorrentes do processo de descentralizacao. Pesquisa qualitativa desenvolvida por meio de grupos operativos com 55 trabalhadores das equipes gestoras de MPP da macrorregiao norte do Parana. Foi realizada analise compreensiva e interpretativa utilizando a Teoria do Jogo Social como referencial teorico. Dentre os problemas, estao a insuficiente capacidade para fazer a gestao dos municipios e para ofertar atencao integral a saude aos municipes. A constituicao de Consorcios Intermunicipais de Saude, a compra de servicos por contratos paralelos com prestadores privados e a adesao a programas do estado e da Uniao sao estrategias para o enfrentamento dos problemas, porem estas desencadeiam um intercâmbio de problemas. Para minimizar a vulnerabilidade dos MPP, e preciso fomentar o empoderamento do gestor municipal, implantar processos de escuta dos MPP e de uma cultura de enfrentamento dos problemas de forma coletiva e compartilhada entre os entes federados, para que haja uma gestao interfederativa.
12 citations
TL;DR: To what extent nurse managers perceive the main challenges, the performance of strategic actors, the dynamics of interagency spaces, and federative agendas necessary to strengthen SUS management in the management process are perceived is analyzed.
Abstract: Resumo Este artigo tem como objetivo analisar o perfil e as percepcoes dos secretarios municipais de saude sobre as agendas e os desafios para o SUS para o ciclo 2017-2020, com enfase na participacao dos enfermeiros na gestao. Os dados foram coletados por meio de questionario eletronico aplicado via web, contendo questoes fechadas, respondido por gestores municipais, no âmbito da Pesquisa Nacional dos Secretarios Municipais de Saude, um estudo de abrangencia nacional, realizado em 26 estados nos anos de 2017 e 2018. Pode-se compreender em que medida, no processo de gestao, os enfermeiros gestores percebem os principais desafios, a atuacao de atores estrategicos, a dinâmica dos espacos intergestores e as agendas federativas que sao necessarias ao fortalecimento da gestao do SUS.
12 citations
TL;DR: The perception of managers of the Councils of Municipal Health Secretariats of the states of Mato Grosso do Sul, Paraná, Ceará, Tocantins and Minas Gerais is analyzed.
Abstract: This study aims to analyze the perception of managers of the Councils of Municipal Health Secretariats (COSEMS) and their contributions to the health regionalization process. We conducted thorough interviews with presidents of COSEMS of the states of Mato Grosso do Sul, Parana, Ceara, Tocantins and Minas Gerais. Data were analyzed with Iramuteq software, which generated a dendrogram with three themes: The first thematic axis: the prominent role of COSEMS in the regional governance process, which includes class 1 - COSEMS' leadership in the process of regionalization, and class 3 - The strategic experience of the regional agreement process. The second thematic axis includes the challenges to the provision of health care in the regions, consisting of class 2, which shows how to meet community needs, and class 4, which shows the local support carried out by COSEMS' teams. The third thematic axis consists of class 5, which describes the operational aspects of the provision of health care in the region. COSEMS play an important role in the regionalization process, especially because they have an organic performance and leadership. Its organic performance in these areas has ensured its legitimacy and leadership. It is a daily construction that ensures the advancement of collaborative governance in health regions.
11 citations
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TL;DR: There are evidences in the international literature on health care networks that these networks may improve the clinical quality, the sanitation results and the user's satisfaction and the reduction of healthcare systems costs.
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TL;DR: The authors define a "neo-institucionalism" which constitui uma corrente de pensamento unificada, i.e., a set of metodos de analise diferentes apareceram nessa area no ultimo quarto de seculo.
Abstract: O neo-institucionalismo nao constitui uma corrente de pensamento unificada. Ao contrario, pelo menos tres metodos de analise diferentes apareceram nessa area no ultimo quarto de seculo: o institucionalismo historico, o institucionalismo da escolha racional e o institucionalismo sociologico. Todas elas tratam, por ângulos diferentes, do papel desempenhado pelas instituicoes na determinacao de resultados sociais e politicos. Expoe-se e examina-se a genese de cada uma dessas variantes do "neo-institucionalismo", assim como o que distingue suas maneiras de tratar dos problemas sociais e politicos.
321 citations
TL;DR: In this paper, the authors analyzed the process of reform in four areas of social policies that affect directly the interests of sub-national governments: basic education, social housing programs, basic sanitation and health.
Abstract: The article analyses the process of reform in four areas of social policies that affect directly the interests of sub-national governments: basic education, social housing programs, basic sanitation and health. As the study reveals, despite the varying degree of success achieved in the various policy initiatives and contrary to the expectations of the prevailing interpretations of the nature of Brazilian federalism, the federal government faced no insurmountable hurdles in implementing their reform agenda. The study aims at demonstrating that (i) in the absence of any constitutional mandatory requirement, the political autonomy of local governments - typical of federative States - actually enhances the veto power of local governments over policy initiatives proposed by the federal Executive branch. However, (ii) power resources available to the federal Executive branch - such as agenda definition and vetoing powers - in addition to control over resources that are essential to the political survival of the representatives increase the chances of success of the federal government. Furthermore, (1999), (iii) the constitutional authority of Brazilian states is far more limited than that of the North-American states; (iv) the category "federalism", however, is not sufficient to define the potential stability of specific policies, which depends upon how inter-governmental relations are structured in each particular policy. Specifically, (v) constitutional rules, legacies from previous policies and the political cycle frame the decision arenas in various ways, thus conditioning both the strategies and chances of success of the federative players.
108 citations
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TL;DR: It is concluded that progress has been made in terms of equity since the establishment of SUS, particularly as reflected in the decentralization of health care policy.
Abstract: This article analyses the issue of equity in the area of health, particularly with regard to health care policy. It presents recent information on the allocation of financial resources and the supply and utilization of health care services throughout a selected group of municipalities in Brazil, and concludes that progress has been made in terms of equity since the establishment of SUS, particularly as reflected in the decentralization of health care policy.
93 citations
TL;DR: In this paper, the authors analyze the processes of decentralization and deconcentration, along with the new emergence of federalism, as global phenomena and meaningful tendencies in the reestructuring of the unitary and centralized State, built under the Napoleonic tradition.
Abstract: The article analyses the processes of decentralization and deconcentration, along with the new emergence of federalism, as global phenomena and meaningful tendencies in the reestructuring of the unitary and centralized State, built under the Napoleonic tradition. In the Brazilian case, in particular, the article identifies the different phases and problems that arose during the decentralization process and within the re-configuration of the federative pact since the 80's, and evaluates the implications of this new order on the recent reform processes of the health policy. Furthermore, the article presents the conditions and limitations of healthsystem's decentralization, highlighting the risks to which it is submitted and taking into account unfavourable aspects of its context, characterised by federative conflicts and by the social and economic inequality inheritance.
83 citations