Abstract
This paper analyzes policies and management tools aimed at the regional organization of specialized care in Ceará. A case study was developed in a health region based on 18 interviews with regional and municipal managers and health professionals and visits to services. Several factors enabled advances in the organization of specialized care: the preponderant role of the State Health Secretariat in the regional health coordination of actions and services, providing infrastructure, financing with redistribution of resources and technical support to municipalities; implantation of regional Polyclinic and Specialized Dental Care Centers through the Public Health Consortium; and logistics support of transport system. The institutional framework of Municipal Health Secretaries Council and the participatory functioning of the Regional Interagency Committee provided adequate space for the regional governance. Challenges remain for the integration of the network, qualification of care regulation, and provision of hospital care in the region. The results reinforce the importance of public and universal arrangements for the provision of comprehensive health care that can reduce inequities.
Highlights
Since the 1990s, several countries have reconfigured their national health systems on a geographical basis with the goal of efficiency, improved access, and quality of care
The identified inequities resulting from mayorization favored arguments towards the strengthening of state governments and the regional organization of health care[5], with the health regions established as the planning and governance locus of the Unified Health System (SUS)
Responses to the 2008 world economic crisis favored the approximation of health systems to regional needs in order to reduce inefficiencies, with a strengthened Primary Health Care (PHC), concentration of specialized care and implementation of management mechanisms for the incorporation of new technologies and medicines[10,11]
Summary
Since the 1990s, several countries have reconfigured their national health systems on a geographical basis with the goal of efficiency, improved access, and quality of care. The reforms included differentiated concentration/deconcentration processes for regional management structures, as well as political-administrative centralization/ decentralization for subnational governments[1,2]. They involved the implementation of instruments for integration and regional coordination of health policies, actions, and services[3]. Responses to the 2008 world economic crisis favored the approximation of health systems to regional needs in order to reduce inefficiencies, with a strengthened PHC, concentration of specialized care and implementation of management mechanisms for the incorporation of new technologies and medicines[10,11]
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