Políticas de saúde e lacunas federativas no Brasil: uma análise da capacidade regional de provisão de serviços

Abstract

This paper analyzes Brazilian health regions according to their service delivery capacity from the debate on the crisis of cooperative federalism in the SUS that resulted from decentralizing process established in the 1988 Constitution. Service delivery capacity tracer indicators were selected by regions and statistical analyses evidenced greater regional capacity in hospital care and large asymmetries with regard to the availability of physicians, high complexity equipment and private insurance coverage. In conclusion,we argue that further solutions are required to strengthen governmental capacity to reduce regional inequalities throughincreased central coordination.

Federalismo e políticas de saúde no Brasil: características institucionais e desigualdades regionais

“…As studies of the redemocratization process in Brazil show 3,15,19,20 , hopes were pinned on the capacity of public policy and the SUS as a paradigm to redistribute resources and tackle health inequalities.…”

“…This study falls within a line of research created in 2013 that examines federalism in Brazil, covering topics such as: the decentralization crisis in the SUS 1 ; political obstacles to regionalization 2 ; regional inequalities based on an analysis of health regions 3 ; the implementation of the Public Actions Organizational Contract (Contrato Organizativo de Ações Públicas -COAP) 4 ; public participation and patterns of deliberative democracy 5,6 ; and decentralization and regulation in relations between public and parastatal assets 7 .…”

Relação público-privada na política brasileira de atenção cardiovascular de alta complexidade

“…Services shall include humane care actions for prevention of diseases, promotion of health and rehabilitation, as well as diagnostic and surgical procedures. Another principle is decentralization: the policy regionalizes the services following demographics and healthcare networks established according to the population's needs (Pinto, Fraga, & Freitas, 2012;Ribeiro et al, 2017).…”

“…In other words, the State can commission the private sector to provide services that the State itself cannot, but the State is not allowed to outsource the provision of the entire demand -even if the demand for public healthcare is larger than the governmental provision of services -as the 1988 Federal Constitution establishes a Unified Health System that is public, comprehensive and all-population-oriented. As such, healthcare is a field that needs strong intervention of both society and the State (Gadelha, Quental, & Fialho, 2003;Gadelha, 2012;Ribeiro, Moreira, Ouverney, & Silva, 2017).…”

Cursos de especialização ofertados no âmbito do Mais Médicos: análise documental na perspectiva da Educação Interprofissional

“…There is a clear concentration of educational institutions in large urban centers, which produces a strong insertion of doctors in these spaces. Consequently, remote areas of Brazil and needy regions of large cities face shortage or a complete absence of doctors 9,10 .…”