Avaliação da Política Estadual de Incentivo Hospitalar (PEIH) como ferramenta para a implementação de políticas públicas de saúde no Estado do Ceará

Abstract

The State Policy for Hospital Incentives (PEIH), established in Ceará in 2021, emerged as a strategy to strengthen the organization of hospital care within the Brazilian Unified Health System (SUS). Its focus is on regionalization, decentralization, and expanding access to medium- and high-complexity services, aiming to reduce regional inequalities and improve the management of hospitals that make up the Health Care Networks (RAS). This dissertation aims to evaluate the PEIH in Ceará, considering its role in providing access to hospital services within the RAS and seeking to contribute to improving efficiency and health outcomes. Specifically, it proposes to analyze the process of regionalization and decentralization of medium- and high-complexity hospital services, understand patient flow through the interaction between the State and civil society, examine the integration of hospitals as strategic points of the RAS, and assess transparency in the disclosure of hospital performance results across the state. The study was conducted using a qualitative approach, including document analysis and a questionnaire applied to the five Regional Health Superintendents of Ceará. It also reviewed the historical and regulatory trajectory of hospital care in Brazil and Ceará, highlighting regionalization and decentralization policies that are essential for understanding the PEIH’s context. The research explored aspects such as state co-financing, the role of regional evaluation committees, patient flow to services, and transparency in disclosing hospital results. Findings revealed significant progress, such as the expansion of hospital care in the countryside, ensuring that the population has access to consultations, exams, and hospitalizations closer to their place of residence. Moreover, the policy has strengthened coordination between referral hospitals and regulation centers, enabling more organized patient referrals. However, challenges were identified regarding monitoring goals and difficulties in tracking real-time production data, as the Hospital Information System (SIH/DataSUS) presents limitations in the timeliness of information. This directly affects managers’ ability to evaluate results and plan corrective actions promptly. The research also highlighted the need to strengthen regional governance and enhance the participation of municipal managers and civil society in guiding the policy. The implementation of more standardized monitoring tools for PEIH was pointed out as essential to improve the policy and promote greater transparency and efficiency in the use of public resources. It is concluded that PEIH plays a strategic role in expanding access to hospital services in the countryside of Ceará, strengthening regional hospitals, and integrating units into the Health Care Networks. The results indicate significant progress in SUS regionalization and care organization but also highlight challenges, such as the need for better coordination among managers and faster availability of monitoring data. Strengthening the Regional Evaluation Committees and adopting technological tools for real-time monitoring are recommended to ensure greater efficiency, transparency, and equity in management. Thus, this research contributes to the improvement of PEIH and reinforces the importance of state-level policies aimed at reducing inequalities and improving the quality of hospital care.