Regionalização da assistência à saúde no estado de Minas Gerais: capacidade de provisão de serviços hospitalares de média complexidade

• Autor(a) principal: Morais, Márcia Moreira de
• Data de Publicação: 2019
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Institucional da Fundação João Pinheiro
• Texto Completo: http://repositorio.fjp.mg.gov.br/handle/tede/440
• topic: Saúde Pública; Regionalização; Minas Gerais; Sistema Único de Saúde (SUS); Serviço de Saúde; Políticas Públicas; Assistência Hospitalar; SAUDE COLETIVA::SAUDE PUBLICA

The regionalization of attention to health and operational and administrative decentralization of the Unified Health System (SUS) are constitutional guidelines established with the enactment of the 1988 Federal Constitution in principle the pro-municipalization movement was more intense during the first decade of organization of SUS and decentralization was more incisive than the strategy of regionalization, without which the guiding principles of the SUS, namely, universality of access, integrality of care and equity, are not achieved. The federated entities, by the nature of the SUS, are obliged to relate and complement each other, since no entity is self-sufficient in the provision of health services and, even if it were, health and epidemiological issues could be affected by an epidemic that began in another municipality or Health Region. In this way, the Brazilian health system is unique and presents itself with a social policy that induced the formation of federative arrangements capable of enforcing the aforementioned principles and guidelines. Thus, in a country of triune and singular federalism, the SUS has induced the formation of intergovernmental relations, which require mechanisms of cooperation and coordination, organized in a process of solidary governance of a network of health services that surpasses or inhibits free rider or opportunists, which weaken the relations and the achievement of health policy objectives. For this, it becomes indispensable control instruments capable of curbing actions motivated only by self-interest or that favors competitive and predatory federalism, which is not cohesive with the solidarity stance of federated entities inherent in the institutional design of SUS. In order to study the dynamics of the regionalization process, this study chose the state of Minas Gerais as a case study and, through the indicator of resolvability of hospital care of medium complexity, sought to identify the level of regionalization achieved. We analyzed the care flows between Health Regions of hospital procedures of medium complexity, MCH1 and MCH2, established by the Regionalization Master Plan of Minas Gerais (PDR / MG) as hospital services portfolio assigned to the territory of 77 (seventy-seven ) Health Regions of the state, as well as the origin of the migrant patient. Statistical analyzes were performed to analyze the cause and effect relationships between the resolvability index reached by the Health Regions and a set of variables that favored the understanding of the results. It was observed that more than 50% (fifty percent) of the Health Regions of Minas Gerais meet with critical and regular resolubility, demonstrating the low responsiveness of the Health Regions to the hospital demand of medium complexity of resident patients and pointing to a high migratory flow of patients between Regions and, in many cases, between Extended Health Regions as well. The temporal analysis between the years 2009 and 2017 showed that the heterogeneity between the Health Regions has increased, as well as the inequality. In addition, it was observed that the supply index created by factor analysis, combining dimensions of infrastructure, human resources and financing is the variable that most explains the variations of the regional resolubility. Migration flows between Regions have shown that the origin of the migrant patient is concentrated, in most cases, in the non-polo municipalities of the Health Region, suggesting weak intergovernmental cooperation and a low territorial governance capacity. In order to overcome uncooperative behavior, the institutionalization of strong legal instruments and the performance of the role of the coordinating, regulating and compensating state entity of inequalities, presents itself as a path towards a strong and solidary regionalization.