Regional governance arrangements of the Brazilian Unified National Health System: provider diversity and spacial inequality in service provision
| Autor(a) principal: | |
|---|---|
| Data de Publicação: | 2019 |
| Outros Autores: | , , , , , , , , |
| Tipo de documento: | Artigo |
| Idioma: | eng por |
| Título da fonte: | Cadernos de Saúde Pública |
| Texto Completo: | https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/6950 |
Resumo: | The study analyzes regional Brazilian Unified National Health System (SUS, in Portuguese) governance arrangements according to providers’ legal sphere and the spacial provision of middle and high-complexity services. These arrangements express the way in which State and health system reforms promoted the redistribution of functions between governmental and private entities in the territory. We carried out an exploratory study based on national-scope secondary data from 2015-2016. Using cluster analysis based on the composition of the provision percentages of the main providers, we classified 438 health regions. In middle-complexity health care, municipal public providers (outpatient) and private philanthropic providers (hospital) predominate. In high complexity provision, philanthropic and for-profit providers (outpatient and hospital) predominate. Middle-complexity provision was recorded in all health regions. However, in 12 states, more than half of the provision is concentrated in only one health region. High-complexity provision is concentrated in state capital regions. Governance arrangements may be more or less diverse and unequal, if different segments and regional concentration levels of middle and high-complexity provision are considered. The study suggests that the convergence between decentralization and mercantilization favored re-scaling of service provision, with increase in the scale of participation of private providers and strengthening of reference municipalities. Governance arrangement characteristics challenge SUS regionalization guided by the collective needs of the population. |
| id |
FIOCRUZ-5_516727533b8cd5af1b52ad8030149e80 |
|---|---|
| oai_identifier_str |
oai:ojs.teste-cadernos.ensp.fiocruz.br:article/6950 |
| network_acronym_str |
FIOCRUZ-5 |
| network_name_str |
Cadernos de Saúde Pública |
| repository_id_str |
|
| spelling |
Regional governance arrangements of the Brazilian Unified National Health System: provider diversity and spacial inequality in service provisionArranjos regionais de governança do Sistema Único de Saúde: diversidade de prestadores e desigualdade espacial na provisão de serviçosDelivery of Health CareRegional Health PlanningGovernancePrivate SectorHealth PolicyAssistência à SaúdeRegionalizaçãoGovernançaSetor PrivadoPolítica de SaúdeThe study analyzes regional Brazilian Unified National Health System (SUS, in Portuguese) governance arrangements according to providers’ legal sphere and the spacial provision of middle and high-complexity services. These arrangements express the way in which State and health system reforms promoted the redistribution of functions between governmental and private entities in the territory. We carried out an exploratory study based on national-scope secondary data from 2015-2016. Using cluster analysis based on the composition of the provision percentages of the main providers, we classified 438 health regions. In middle-complexity health care, municipal public providers (outpatient) and private philanthropic providers (hospital) predominate. In high complexity provision, philanthropic and for-profit providers (outpatient and hospital) predominate. Middle-complexity provision was recorded in all health regions. However, in 12 states, more than half of the provision is concentrated in only one health region. High-complexity provision is concentrated in state capital regions. Governance arrangements may be more or less diverse and unequal, if different segments and regional concentration levels of middle and high-complexity provision are considered. The study suggests that the convergence between decentralization and mercantilization favored re-scaling of service provision, with increase in the scale of participation of private providers and strengthening of reference municipalities. Governance arrangement characteristics challenge SUS regionalization guided by the collective needs of the population.El estudio analiza las modalidades regionales de gestión en el Sistema Único de Salud (SUS), según la categoría jurídica de los prestadores y la distribución espacial para la provisión de servicios de media y alta complejidad en Brasil. Tales modalidades expresan el modo mediante el cual la reforma del Estado y del sistema de salud promovieron la redistribución de funciones entre entes gubernamentales y privados en el territorio nacional. Se realizó un estudio exploratorio, basado en datos secundarios de alcance nacional, durante el bienio 2015-2016. Mediante un análisis de agrupamientos, basado en la composición de porcentajes relacionados con la provisión de servicios de los principales prestadores, se clasificaron 438 regiones de salud. En la asistencia de media complejidad, predominó el prestador público municipal (ambulatorio) y el prestador privado filantrópico (hospitalario). En la alta complejidad, predominó el prestador filantrópico y lucrativo (ambulatorio y hospitalario). La provisión de media complejidad se registró en todas las regiones de salud, sin embargo, en 12 estados, más de la mitad de la misma está concentrada en sólo una región de salud. La producción de alta complejidad está concentrada en las regiones de las capitales de los estados. Las modalidades de gestión pueden ser más o menos diversas y desiguales, si se consideran los diferentes segmentos y niveles de concentración regional en la provisión de servicios de media y alta complejidad. El estudio sugiere que la convergencia entre descentralización y mercantilización favoreció el reescalonamiento de la función de prestación de servicios, con una ampliación de la escala de actuación de prestadores privados y el fortalecimiento de los municipios más importantes. Las características de las modalidades de gestión desafían la regionalización del SUS, orientada por las necesidades colectivas de las poblaciones.O estudo analisa os arranjos regionais de governança do Sistema Único de Saúde (SUS), segundo esfera jurídica dos prestadores e distribuição espacial da produção de serviços de média e alta complexidade no Brasil. Tais arranjos expressam o modo como a reforma do Estado e do sistema de saúde promoveram a redistribuição de funções entre entes governamentais e privados no território. Realizou-se estudo exploratório com base em dados secundários de abrangência nacional, do biênio 2015-2016. Por meio da análise de agrupamentos baseada na composição dos percentuais da produção dos principais prestadores, foram classificadas 438 regiões de saúde. Na assistência de média complexidade, predominou o prestador público municipal (ambulatorial) e o prestador privado filantrópico (hospitalar). Na alta complexidade, predominou o prestador filantrópico e lucrativo (ambulatorial e hospitalar). A produção de média complexidade foi registrada em todas as regiões de saúde, porém, em 12 estados, mais da metade dela está concentrada em apenas uma região de saúde. A produção de alta complexidade é concentrada nas regiões das capitais estaduais. Os arranjos de governança podem ser mais ou menos diversos e desiguais, se considerados os diferentes segmentos e níveis de concentração regional da produção de média e alta complexidade. O estudo sugere que a convergência entre descentralização e mercantilização favoreceu o reescalonamento da função de prestação de serviços, com ampliação da escala de atuação de prestadores privados e fortalecimento dos municípios polos. As características dos arranjos de governança desafiam a regionalização do SUS orientada pelas necessidades coletivas das populações.Reports in Public HealthCadernos de Saúde Pública2019-06-13info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmltext/htmlapplication/pdfapplication/pdfhttps://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/6950Reports in Public Health; Vol. 35 No. 14 (2019): Supplement 2Cadernos de Saúde Pública; v. 35 n. 14 (2019): Suplemento 21678-44640102-311Xreponame:Cadernos de Saúde Públicainstname:Fundação Oswaldo Cruz (FIOCRUZ)instacron:FIOCRUZengporhttps://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/6950/15096https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/6950/15097https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/6950/15098https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/6950/15099Luciana Dias de LimaMariana Vercesi de AlbuquerqueJoão Henrique Gurtler ScatenaEnirtes Caetano Prates de MeloEvangelina Xavier Gouveia de OliveiraMarilia Sá CarvalhoAdelyne Maria Mendes PereiraRicardo Antunes Dantas de OliveiraNereide Lucia MartinelliClarice Furtado de Oliveirainfo:eu-repo/semantics/openAccess2024-03-06T15:29:38Zoai:ojs.teste-cadernos.ensp.fiocruz.br:article/6950Revistahttps://cadernos.ensp.fiocruz.br/ojs/index.php/csphttps://cadernos.ensp.fiocruz.br/ojs/index.php/csp/oaicadernos@ensp.fiocruz.br||cadernos@ensp.fiocruz.br1678-44640102-311Xopendoar:2024-03-06T13:07:57.976809Cadernos de Saúde Pública - Fundação Oswaldo Cruz (FIOCRUZ)true |
| dc.title.none.fl_str_mv |
Regional governance arrangements of the Brazilian Unified National Health System: provider diversity and spacial inequality in service provision Arranjos regionais de governança do Sistema Único de Saúde: diversidade de prestadores e desigualdade espacial na provisão de serviços |
| title |
Regional governance arrangements of the Brazilian Unified National Health System: provider diversity and spacial inequality in service provision |
| spellingShingle |
Regional governance arrangements of the Brazilian Unified National Health System: provider diversity and spacial inequality in service provision Luciana Dias de Lima Delivery of Health Care Regional Health Planning Governance Private Sector Health Policy Assistência à Saúde Regionalização Governança Setor Privado Política de Saúde |
| title_short |
Regional governance arrangements of the Brazilian Unified National Health System: provider diversity and spacial inequality in service provision |
| title_full |
Regional governance arrangements of the Brazilian Unified National Health System: provider diversity and spacial inequality in service provision |
| title_fullStr |
Regional governance arrangements of the Brazilian Unified National Health System: provider diversity and spacial inequality in service provision |
| title_full_unstemmed |
Regional governance arrangements of the Brazilian Unified National Health System: provider diversity and spacial inequality in service provision |
| title_sort |
Regional governance arrangements of the Brazilian Unified National Health System: provider diversity and spacial inequality in service provision |
| author |
Luciana Dias de Lima |
| author_facet |
Luciana Dias de Lima Mariana Vercesi de Albuquerque João Henrique Gurtler Scatena Enirtes Caetano Prates de Melo Evangelina Xavier Gouveia de Oliveira Marilia Sá Carvalho Adelyne Maria Mendes Pereira Ricardo Antunes Dantas de Oliveira Nereide Lucia Martinelli Clarice Furtado de Oliveira |
| author_role |
author |
| author2 |
Mariana Vercesi de Albuquerque João Henrique Gurtler Scatena Enirtes Caetano Prates de Melo Evangelina Xavier Gouveia de Oliveira Marilia Sá Carvalho Adelyne Maria Mendes Pereira Ricardo Antunes Dantas de Oliveira Nereide Lucia Martinelli Clarice Furtado de Oliveira |
| author2_role |
author author author author author author author author author |
| dc.contributor.author.fl_str_mv |
Luciana Dias de Lima Mariana Vercesi de Albuquerque João Henrique Gurtler Scatena Enirtes Caetano Prates de Melo Evangelina Xavier Gouveia de Oliveira Marilia Sá Carvalho Adelyne Maria Mendes Pereira Ricardo Antunes Dantas de Oliveira Nereide Lucia Martinelli Clarice Furtado de Oliveira |
| dc.subject.por.fl_str_mv |
Delivery of Health Care Regional Health Planning Governance Private Sector Health Policy Assistência à Saúde Regionalização Governança Setor Privado Política de Saúde |
| topic |
Delivery of Health Care Regional Health Planning Governance Private Sector Health Policy Assistência à Saúde Regionalização Governança Setor Privado Política de Saúde |
| description |
The study analyzes regional Brazilian Unified National Health System (SUS, in Portuguese) governance arrangements according to providers’ legal sphere and the spacial provision of middle and high-complexity services. These arrangements express the way in which State and health system reforms promoted the redistribution of functions between governmental and private entities in the territory. We carried out an exploratory study based on national-scope secondary data from 2015-2016. Using cluster analysis based on the composition of the provision percentages of the main providers, we classified 438 health regions. In middle-complexity health care, municipal public providers (outpatient) and private philanthropic providers (hospital) predominate. In high complexity provision, philanthropic and for-profit providers (outpatient and hospital) predominate. Middle-complexity provision was recorded in all health regions. However, in 12 states, more than half of the provision is concentrated in only one health region. High-complexity provision is concentrated in state capital regions. Governance arrangements may be more or less diverse and unequal, if different segments and regional concentration levels of middle and high-complexity provision are considered. The study suggests that the convergence between decentralization and mercantilization favored re-scaling of service provision, with increase in the scale of participation of private providers and strengthening of reference municipalities. Governance arrangement characteristics challenge SUS regionalization guided by the collective needs of the population. |
| publishDate |
2019 |
| dc.date.none.fl_str_mv |
2019-06-13 |
| dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion |
| format |
article |
| status_str |
publishedVersion |
| dc.identifier.uri.fl_str_mv |
https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/6950 |
| url |
https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/6950 |
| dc.language.iso.fl_str_mv |
eng por |
| language |
eng por |
| dc.relation.none.fl_str_mv |
https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/6950/15096 https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/6950/15097 https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/6950/15098 https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/6950/15099 |
| dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
| eu_rights_str_mv |
openAccess |
| dc.format.none.fl_str_mv |
text/html text/html application/pdf application/pdf |
| dc.publisher.none.fl_str_mv |
Reports in Public Health Cadernos de Saúde Pública |
| publisher.none.fl_str_mv |
Reports in Public Health Cadernos de Saúde Pública |
| dc.source.none.fl_str_mv |
Reports in Public Health; Vol. 35 No. 14 (2019): Supplement 2 Cadernos de Saúde Pública; v. 35 n. 14 (2019): Suplemento 2 1678-4464 0102-311X reponame:Cadernos de Saúde Pública instname:Fundação Oswaldo Cruz (FIOCRUZ) instacron:FIOCRUZ |
| instname_str |
Fundação Oswaldo Cruz (FIOCRUZ) |
| instacron_str |
FIOCRUZ |
| institution |
FIOCRUZ |
| reponame_str |
Cadernos de Saúde Pública |
| collection |
Cadernos de Saúde Pública |
| repository.name.fl_str_mv |
Cadernos de Saúde Pública - Fundação Oswaldo Cruz (FIOCRUZ) |
| repository.mail.fl_str_mv |
cadernos@ensp.fiocruz.br||cadernos@ensp.fiocruz.br |
| _version_ |
1798943388102295552 |