A regionalização do acesso a saúde: facilitando fluxos ou construindo barreiras?

Abstract

Since the consolidation of the Unified Health System (SUS), there has been a commitment of political and technical forces to implement organizational arrangements that express the most appropriate design for effective access to health in territories with continental geographical boundaries, such as Brazil. However, historically, when we focus on the assistance paths of users who need to migrate from basic care (AB) to specialized care (AE), a persistent departmentalization of health services is evident, which weakens the integrality of care and the flows of the Users. In this way, the State has invested in the regionalization of health as a powerful strategy to increase the reach of the services offered, in order to meet the needs of users with higher quality and lower investment cost. Thus, this study intends to understand how the regulation of access to specialized care happens, from a regionalized perspective of health. It is a study rooted in epistemological grounds of qualitative research, which has as an interest the experiences and processes of meanings of subjects inserted in the health scenario. We interviewed 9 users and 5 managers from the health area of ​​Russas, state of Ceará, from January to April 2016. The interviews were collected at the outpatient and specialized outpatient clinic (polyclinic). In-depth interviews were conducted, seeking to reconstitute the care trajectories of users. In addition, we use annotations in field diary and observation of health services. The construction of information had as its lens the perspective of empirical phenomenology, from which three units of meanings were unveiled. The first unit of meaning was the organization of regionalised access flows, pointing to the flows institutionalized by the protocols of access to EAs implanted under a very structural and bureaucratic logic, culminating in access barriers and leading users to track parallel paths. In the second unit, the core of the analyzes focused on the management of regional regulatory practices, revealing the strategies used by managers to guarantee regionalised access flows, such as systematic control of job vacancies, matriciation between AE and AB, use of Technologies Of information and communication in the process of regulating regional access. Finally, we present the management of regulatory practices based on the internal organization of the referral service, mainly discussing - from the care trajectories - the impact that the geographical accessibility has on access to users' health, the importance of sanitary transportation and prioritization Of more distant municipalities. It is concluded that the modeling of health services, from the regionalized perspective of health, is a necessary and inevitable solution for a country of continental dimensions. However, strong logistical and support systems must be struc- tured in order to achieve full health at all levels.