Os caminhos da regionalização da saúde no Brasil: adequação e acesso geográfico nos anos 2000

Abstract

his article aims to analyze the consistency of the health regionalization process in Brazil, based on quantitative indicators of adequacy and geographic access. Regional dropout rates, average distances covered, and average travel times are estimated considering all regions of the country and disaggregated by state, for hospitalizations of medium complexity in SUS. Microsimulation exercises identify the effects of changes in the design of health regions in relation to changes in the use of health services in the years 2002, 2008, 2011 and 2015. The main results indicate that the spatiality of patient flows is primarily internal to the very health region, since that is where most of the consultations take place. Cross border movements to other health regions imply distances of over 100 km. The changes in regionalization had greater effect in the states of the North Region. The normative regionalization process without a correspondence with the optimization and improvement of the regional distribution of the provision can generate advances in some aspects f the regionalization, but it has little effect on the geographic access, measured in this work by the indicators of average distance traveled and the evasion rate.