Regulação assistencial e integralidade na assistência à saúde em Vitória-ES, sob a perspectiva da análise institucional
Autor(a) principal: | |
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Data de Publicação: | 2010 |
Tipo de documento: | Dissertação |
Idioma: | por |
Título da fonte: | Repositório Institucional da Universidade Federal do Espírito Santo (riUfes) |
Texto Completo: | http://repositorio.ufes.br/handle/10/5436 |
Resumo: | This research deals with the access regulation to the health services workers network, public and private, contracted in order to guarantee the population access to the specialized assistance resources and its close relationship with the integrality guideline and principle, in the district of Vitoria-ES. It focus on integrality, in its individual clinical dimension, as axis, and the assistance access regulation, as cutout, on the macro-regulation scope in the public health systems, as well as the inter relation between these two dimensions. Seize the municipal different managements as object to examine the regulation rules and practices process of institutionalization and its effects in terms of provide integral attention to the district citizens. In this way this study searched to uncover the process of institutional change that took place in the Vitoria’s Municipal Health Secretariat throughout the twenty years of implantation of the Single Health System, through qualitative, exploratory, descriptive and analytical study, supported by documental sources and semi-structured interviews with the municipal health secretaries who managed during the period of 1989 to 2009. Anchored on the historical neo-institutionalism and on the concept of path dependency, the empirical data analyses demonstrate that the decisions made in the past impacted on the future trajectory of the health politics, either provoking incremental advances, or provoking embarrassments in the integral attention to the population and in the regulatory process. As results the indicators selected and elaborated point to relevant incremental advances towards integrality. The path dependency reveals itself in its most remarkable form in the managements in which were proposed institutional innovations whose conception brought as substrate political projects of different coalitions in the municipal management. These expressed themselves in the condition of municipal habilitation with the Health Ministry, in the attention model and organizational arrangements, in the assistance planning and in the State Health Secretariat informal relationships with the workers network. It reveals that, in a scenery of the private sector dependence, the Single Health System demands more effective instruments in order to firm with the workers network the state regulatory force. It still indicates the need for new investigations to enlarge the necessary knowledge to build capable means to measure the regulated integrality ... population access to the secondary and tertiary ... public health services systems. |
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Bussinger, Elda Coelho de AzevedoSilva, Marta Zorzal eSiqueira, Márcia PortugalLima, Rita de Cássia DuarteCastro, Cláudio Gastão Junqueira deFigueiredo, Túlio Alberto Martins de2016-08-30T10:50:07Z2016-07-112016-08-30T10:50:07Z2010-07-08This research deals with the access regulation to the health services workers network, public and private, contracted in order to guarantee the population access to the specialized assistance resources and its close relationship with the integrality guideline and principle, in the district of Vitoria-ES. It focus on integrality, in its individual clinical dimension, as axis, and the assistance access regulation, as cutout, on the macro-regulation scope in the public health systems, as well as the inter relation between these two dimensions. Seize the municipal different managements as object to examine the regulation rules and practices process of institutionalization and its effects in terms of provide integral attention to the district citizens. In this way this study searched to uncover the process of institutional change that took place in the Vitoria’s Municipal Health Secretariat throughout the twenty years of implantation of the Single Health System, through qualitative, exploratory, descriptive and analytical study, supported by documental sources and semi-structured interviews with the municipal health secretaries who managed during the period of 1989 to 2009. Anchored on the historical neo-institutionalism and on the concept of path dependency, the empirical data analyses demonstrate that the decisions made in the past impacted on the future trajectory of the health politics, either provoking incremental advances, or provoking embarrassments in the integral attention to the population and in the regulatory process. As results the indicators selected and elaborated point to relevant incremental advances towards integrality. The path dependency reveals itself in its most remarkable form in the managements in which were proposed institutional innovations whose conception brought as substrate political projects of different coalitions in the municipal management. These expressed themselves in the condition of municipal habilitation with the Health Ministry, in the attention model and organizational arrangements, in the assistance planning and in the State Health Secretariat informal relationships with the workers network. It reveals that, in a scenery of the private sector dependence, the Single Health System demands more effective instruments in order to firm with the workers network the state regulatory force. It still indicates the need for new investigations to enlarge the necessary knowledge to build capable means to measure the regulated integrality ... population access to the secondary and tertiary ... public health services systems.A pesquisa trata da regulação do acess o à rede de prestadores de ser viços de saúde, públicos e privados, contratualizados para a garantia do acesso da população aos recursos assistenciais especializados e sua estreita relação com a diretriz e o princípio da integralidade, no município de Vitória-ES. Focaliza a integralidade, em sua dimensão clínica individual, como eixo, e a regulação do acesso assistencial, como recorte, no âmbito da macrorregulação nos sistemas de saúde pública, bem como a inter-relação entre essas duas dimensões. Toma as diferentes gestões municipais como objeto para examinar o processo de institucionalização das regras e práticas de regulação e seus efeitos em termos de propiciar atenção integral aos munícipes. Para tanto, buscou desvelar o processo de mudança institucional realizada na Secretaria Municipal de Saúde de Vitória ao longo de vinte anos de implantação do SUS, por meio de estudo de caráter qualitativo, exploratório, descritivo e analítico, apoiado em fontes documentais e entrevistas semiestruturadas, realizadas com os secretários municipais de saúde que atuaram no período de 1989 a 2009. Ancorada no neoinstitucionalismo histórico e no conceito de path dependency, a análise dos dados empíricos demonstra que as decisões tomadas no passado impactaram a trajetória futura da política de saúde, ora provocando avanços incrementais, ora provocando constrangimentos na atenção integral à população e no processo regulatório. Como resultado, os indicadores selecionados e os elaborados apontam avanços incrementais relevantes relativos à integralidade. A path dependency se revelou de forma mais marcante nas gestões em que for am propostas inovações institucionais cuja concepção trazia por substrato projetos políticos de diferentes coalizões na direção municipal. Estas se expressaram na condição de habilitação do município junto ao Ministério da Saúde, no modelo de atenção e arranjos organizacionais, no planejamento assistencial e nas relações informais da SESA com a rede de prestadores. Revelou que, num cenário de dependência do setor privado, o SUS exige instrumentos mais eficazes para firmar junto à rede de prestadores a força regulatória do Estado. Indica, ainda, a necessidade de novas investigações para ampliar o conhecimento necessário à construção de meios capazes de mensurar a influência da integralidade regulada na garantia do acesso da população aos níveis secundário e terciário, na realidade concreta dos sistemas de serviços de saúde pública.Texthttp://repositorio.ufes.br/handle/10/5436porUniversidade Federal do Espírito SantoMestrado em Saúde ColetivaPrograma de Pós-Graduação em Saúde ColetivaUFESBRCentro de Ciências da SaúdePublic healthGovernment regulationComprehensive health careRegulação governamentalAssistência integral à saúdeRegulamentação governamentalSaúde públicaSaúde Coletiva614Regulação assistencial e integralidade na assistência à saúde em Vitória-ES, sob a perspectiva da análise institucionalinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da Universidade Federal do Espírito Santo (riUfes)instname:Universidade Federal do Espírito Santo (UFES)instacron:UFESORIGINALtese_4044_2008_Marcia Portugal Siqueira.pdfapplication/pdf29652270http://repositorio.ufes.br/bitstreams/a6097182-3266-40d0-bb6c-f9916e072b40/download802ccb0ebe4125c2da5608ff5c62fbf5MD5110/54362024-06-27 11:02:10.917oai:repositorio.ufes.br:10/5436http://repositorio.ufes.brRepositório InstitucionalPUBhttp://repositorio.ufes.br/oai/requestopendoar:21082024-06-27T11:02:10Repositório Institucional da Universidade Federal do Espírito Santo (riUfes) - Universidade Federal do Espírito Santo (UFES)false |
dc.title.none.fl_str_mv |
Regulação assistencial e integralidade na assistência à saúde em Vitória-ES, sob a perspectiva da análise institucional |
title |
Regulação assistencial e integralidade na assistência à saúde em Vitória-ES, sob a perspectiva da análise institucional |
spellingShingle |
Regulação assistencial e integralidade na assistência à saúde em Vitória-ES, sob a perspectiva da análise institucional Siqueira, Márcia Portugal Public health Government regulation Comprehensive health care Regulação governamental Assistência integral à saúde Regulamentação governamental Saúde pública Saúde Coletiva 614 |
title_short |
Regulação assistencial e integralidade na assistência à saúde em Vitória-ES, sob a perspectiva da análise institucional |
title_full |
Regulação assistencial e integralidade na assistência à saúde em Vitória-ES, sob a perspectiva da análise institucional |
title_fullStr |
Regulação assistencial e integralidade na assistência à saúde em Vitória-ES, sob a perspectiva da análise institucional |
title_full_unstemmed |
Regulação assistencial e integralidade na assistência à saúde em Vitória-ES, sob a perspectiva da análise institucional |
title_sort |
Regulação assistencial e integralidade na assistência à saúde em Vitória-ES, sob a perspectiva da análise institucional |
author |
Siqueira, Márcia Portugal |
author_facet |
Siqueira, Márcia Portugal |
author_role |
author |
dc.contributor.advisor-co1.fl_str_mv |
Bussinger, Elda Coelho de Azevedo |
dc.contributor.advisor1.fl_str_mv |
Silva, Marta Zorzal e |
dc.contributor.author.fl_str_mv |
Siqueira, Márcia Portugal |
dc.contributor.referee1.fl_str_mv |
Lima, Rita de Cássia Duarte |
dc.contributor.referee2.fl_str_mv |
Castro, Cláudio Gastão Junqueira de |
dc.contributor.referee3.fl_str_mv |
Figueiredo, Túlio Alberto Martins de |
contributor_str_mv |
Bussinger, Elda Coelho de Azevedo Silva, Marta Zorzal e Lima, Rita de Cássia Duarte Castro, Cláudio Gastão Junqueira de Figueiredo, Túlio Alberto Martins de |
dc.subject.eng.fl_str_mv |
Public health Government regulation Comprehensive health care |
topic |
Public health Government regulation Comprehensive health care Regulação governamental Assistência integral à saúde Regulamentação governamental Saúde pública Saúde Coletiva 614 |
dc.subject.por.fl_str_mv |
Regulação governamental Assistência integral à saúde Regulamentação governamental Saúde pública |
dc.subject.cnpq.fl_str_mv |
Saúde Coletiva |
dc.subject.udc.none.fl_str_mv |
614 |
description |
This research deals with the access regulation to the health services workers network, public and private, contracted in order to guarantee the population access to the specialized assistance resources and its close relationship with the integrality guideline and principle, in the district of Vitoria-ES. It focus on integrality, in its individual clinical dimension, as axis, and the assistance access regulation, as cutout, on the macro-regulation scope in the public health systems, as well as the inter relation between these two dimensions. Seize the municipal different managements as object to examine the regulation rules and practices process of institutionalization and its effects in terms of provide integral attention to the district citizens. In this way this study searched to uncover the process of institutional change that took place in the Vitoria’s Municipal Health Secretariat throughout the twenty years of implantation of the Single Health System, through qualitative, exploratory, descriptive and analytical study, supported by documental sources and semi-structured interviews with the municipal health secretaries who managed during the period of 1989 to 2009. Anchored on the historical neo-institutionalism and on the concept of path dependency, the empirical data analyses demonstrate that the decisions made in the past impacted on the future trajectory of the health politics, either provoking incremental advances, or provoking embarrassments in the integral attention to the population and in the regulatory process. As results the indicators selected and elaborated point to relevant incremental advances towards integrality. The path dependency reveals itself in its most remarkable form in the managements in which were proposed institutional innovations whose conception brought as substrate political projects of different coalitions in the municipal management. These expressed themselves in the condition of municipal habilitation with the Health Ministry, in the attention model and organizational arrangements, in the assistance planning and in the State Health Secretariat informal relationships with the workers network. It reveals that, in a scenery of the private sector dependence, the Single Health System demands more effective instruments in order to firm with the workers network the state regulatory force. It still indicates the need for new investigations to enlarge the necessary knowledge to build capable means to measure the regulated integrality ... population access to the secondary and tertiary ... public health services systems. |
publishDate |
2010 |
dc.date.issued.fl_str_mv |
2010-07-08 |
dc.date.accessioned.fl_str_mv |
2016-08-30T10:50:07Z |
dc.date.available.fl_str_mv |
2016-07-11 2016-08-30T10:50:07Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/masterThesis |
format |
masterThesis |
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publishedVersion |
dc.identifier.uri.fl_str_mv |
http://repositorio.ufes.br/handle/10/5436 |
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http://repositorio.ufes.br/handle/10/5436 |
dc.language.iso.fl_str_mv |
por |
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por |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
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openAccess |
dc.format.none.fl_str_mv |
Text |
dc.publisher.none.fl_str_mv |
Universidade Federal do Espírito Santo Mestrado em Saúde Coletiva |
dc.publisher.program.fl_str_mv |
Programa de Pós-Graduação em Saúde Coletiva |
dc.publisher.initials.fl_str_mv |
UFES |
dc.publisher.country.fl_str_mv |
BR |
dc.publisher.department.fl_str_mv |
Centro de Ciências da Saúde |
publisher.none.fl_str_mv |
Universidade Federal do Espírito Santo Mestrado em Saúde Coletiva |
dc.source.none.fl_str_mv |
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