Indução centralizada da coordenação dos cuidados pela atenção primária: estudo comparativo entre dois sistemas de saúde universais

Abstract

The coordination of care for the primary health care (PHC) occupies a prominent position on the agenda of the health policies of various countries. It is a possible alternative to the problem of segmentation of health systems, which generates inequity and inefficiency, disarticulation of the care network and impaired access to more complex levels of care. The general objective of this study was to compare the centralized induction of coordination of care by PHC in two universal health systems. This study has a quantitative and qualitative approach and it is classified as exploratory and descriptive, by using documental and budgetary data and performing nine semistructured interviews with key subjects corresponding to National Health Service (NHS), from the United Kingdom, and the Unified Health System (SUS) in Brazil. The thematic content analysis, descriptive statistics and e comparative analysis were used. The research followed the Resolution 196/96 of the National Health Council and obtained its assent under number 198 092. The research identified that the strengthening of PHC is the initial basis to facilitate the coordination of care in Brazil. The Ministry of Health of Brazil has been developing national policies which impact indirectly on coordination of care - National Policy for Primary Care, Centers of Support for Family Health and the National Program for Improving Access and Quality of Primary Care. The Politics of Health Care Networks proved to be limiting factor for coordinating role of the PHC. The Information and Communication Technologies have emerged with less emphasis on the federal level. The structural increase in Brazil´s Telehealth Networks and Protocols Notebooks of Primary Care, stood by their ability to induce changes in the organizational processes of the services. The NHS structured care coordination by PHC from the contract of general practitioners and seeks to empower them to manage 60% of the budget system. The research concluded that the brazilian federal State model complicates the coordination of care by PHC, compared to the english unitary State. The municipalization and decentralization made the process of coordination of care more complex, leaving to the Ministry of Health the role of inducing vertically and, to the municipalities, operate the system at each point of care in a horizontal manner, a situation which was not well aligned and configured an oblique model, generating a contradiction in the brazilian federal design and bringing difficulties to the coordination of care.