O agir leigo e a produção de mapas de cuidado mistos público-privados

Abstract

This paper discusses part of the results obtained from a study carried out in two cities

Promoção da saúde no setor suplementar: terceirização, microrregulação e implicações no cuidado

“…Another study (7) showed that rationalizing measures, such as non-authorization for hospitalization or special and high cost procedures, adopted by corporations, have a direct impact on assisting beneficiaries and, in general, are transformed into problems between the provider and the user, as the corporation "removes responsibility" of the care transferred to the providers. Thus, it is noted that the outsourcing process implies a delay and loss of quality of service provided from the perspective of capturing, interpreting and serving the needs of beneficiaries.…”

“…It is highlighted that microregulation is a fairly autonomous territory or immune in relationship to regulatory measures and regulation by the ANS and, on that basis, it operates with its own logic, dictated on the one side by the protagonism of multiple actors, with their interests, and on the other, by the existence of certain regulations or rules external to the field (7,17) .…”

“…This regulation, however, seems to be the subject of disputes in supplementary health care, where user assistance is established from the corporation-provider-user relationship, but dictated by an external regulation determined by ANS (2) . The stresses in the field of supplementary health care are not new, and are characterized by a profound process of rationalization, with the submission of health institutions to an economic logic, outsourcing of services, increasing automation of diagnostic processes, dismemberment of the global medical act on multiple diagnostic and therapeutic acts performed by various professionals, whether or not they are physicians (7) . Considering that the ANS has the corporation's ability to remain in the market, the rights of users, and the products, values and coverage of the programs as targets of the regulation (2) , it is understood that there are aspects of the programs of health promotion offered that cross the relationship between corporation-provider-user, and which are on the margins of the macro-regulatory process.…”

“…In the relationship between corporations and providers, these mechanisms are manifested in the form of contracts, payment and nonfinancial instruments of regulation, such as the existence and availability of professionals, restrictions on the use and access to certain intermediary services, in the adoption of prior authorizations, in auditing procedures, among other mechanisms (8) . Microregulation also focuses on the relationship between providers and users with devices that influence the "choices" and the utilization of users about the professional and health facilities; as well as in the care delivery space with the relationships that are established in the encounter between workers and beneficiaries (7) . The implications of this relationship that is established between providers and users is marked by the interests in dispute of the actors in the outsourcing of supplementary care, and are not always explicit.…”

Óbitos neonatais em região de alta vulnerabilidade do Município de Santos, São Paulo, Brasil: examinando questões assistenciais na perspectiva das mulheres

“…Tornando a situação ainda mais difícil, verifica-se que cada indivíduo usuário da saúde pode fazer uso, quer da assistência pública, quer da privada, sem que necessariamente exista uma articulação das ações desenvolvidas em cada uma ou alguma forma de interação entre os serviços. Embora o acesso aos diferentes serviços exista, a questão poderia ser pensada em termos de qual dos setores terá o domínio de competências para a gestão do cuidado, o que vem sendo feito pelo próprio paciente sem que os serviços tenham acesso a todas as informações sobre a assistência prestada 27 . Afinal, a literatura já aponta para a necessidade de processos que fortaleçam a regulação, avaliações, monitoramento e auditorias para garantir padrão semelhante de atenção a todos os usuários, visando à inserção efetiva do setor privado numa rede regionalizada e racionalizada de serviços de saúde 28 .…”