Modelos tecno-assistenciais em saúde: da pirâmide ao círculo, uma possibilidade a ser explorada

Abstract

The technical health care model that portrays the health system as a pyramid with ascending and descending flows of users obtaining access to differentiated levels of technological complexity within articulated reference and counter-reference processes has been conceived as a rationalizing perspective, the merit of which would be to provide greater efficiency in the use of resources, in addition to universal, equitable access. In practical terms, by assuming that facts occur differently than intended under a certain technocratic rationality, the author provides some explanations for this "distortion". He also defends the idea that the health system would be more adequately thought of as a circle, containing multiple "portals of entry" located at several points in the system rather than at a presupposed "base". The author also questions the sense of a "top level", a kind of expression related to a certain "technological hierarchy" with the hospital occupying the apex. At the same time he highlights the health system as an entity to be organized focusing on what is most relevant to each user, offering the most adequate technology in the right place and at the most appropriate time.

Mães de recém-nascidos hospitalizados: em/entre círculos no processo de amamentação

“…Também pôde ser associada à ideia de movimento, com alternativas de entrada e saída, admitindose, assim, possibilidades em uma lógica não hierarquizada (11) . A imagem de círculo foi associada à qualidade de apresentarse como vicioso ou como virtuoso.…”

Acessibilidade às ações básicas entre crianças atendidas em serviços de pronto-socorro

“…1,2 In these circumstances, it would be the result of connecting up the services, each one doing their bit . Therefore, the health units responsible for primary care would be run at a suitable level of care, presuming high level of resolution of basic demands and acting as an entrance portal to secondary care (specialized clinics, diagnosis and therapy support services, some emergency units) and tertiary (more complex hospital services), requiring high diagnostic sensitivity in order to achieve correct referrals within the care system.…”

Livros

“…da produção singular de "mapas de cuidado" Tomo a liberdade de iniciar esta resenha do livro "Os Mapas do Cuidado: o agir leigo na saúde", organizado por Luiz Carlos de Oliveira Cecílio, Graça Carapinheiro e Rosemarie Andreazza, com um subtítulo que contém uma alusão, carinhosa, a um artigo de Luiz Cecílio 1 , que, na época, impactou profundamente o meu modo de pensar o sistema de saúde e de cujas ideias ali apresentadas compartilho até hoje. No presente livro, os autores recuperam -desta vez, apoiando-se em densa pesquisa empírica -e, em muitos aspectos, superam a tese inicialmente explorada por Cecílio em 1997.…”