Regionalização e dinâmica política do federalismo sanitário brasileiro

Abstract

The implications from the Brazilian federal structure on the regionalization of health actions and services in the National Unified Health System (SUS) were analyzed, considering that the regional health planning in Brazil takes place within the context of intergovernmental relations as an expression of cooperative federalism in health. The analysis was based on a historical approach to Brazilian health federalism, recognizing two development periods, decentralization and regionalization. Regional health planning of SUS was explored in light of the theoretical framework of federalism. It is concluded that relative centralization of the process is needed in intergovernmental committees to actualize federal coordination and that it is essential to consider formalizing opportunities for dissent, both in regional management boards and in the intergovernmental committees, so that the consensus decision-making can be accomplished in healthcare regionalization.

Austeridade, predominância privada e falha de governo na saúde

“…In 2011, 79.5% of those insured after the creation of the ANS had a collective or corporate plan 42 . As shown by Table 3, proportions of individuals and families with private health insurance in Brazil are directly associated with family income.…”

A implementação de redes de atenção e os desafios da governança regional em saúde na Amazônia Legal: uma análise do Projeto QualiSUS-Rede

“…Analyzes about the municipalist realm of the Brazilian health system show diverse results and are strongly conditioned by the context of implementation, reflecting the realities of the municipalities and the political will of governmental stakeholders 1,5,6 . This setting has placed at the center of the debate the need to reconcile health policy decentralization with regionalization strategies in order to promote more complementary intergovernmental relations, balance autonomy and interdependence between government entities, encourage the formalization of agreements and organize an integrated health system at regional level 5,[7][8][9] .…”

“…Norms and guidelines were then published to give materiality to regionalization 2,5,7,8 . In this process, parameters were established to define territorial distribution (health regions) and interregional collegiates were established, with representatives of the different spheres of government responsible for conducting health policy at the regional level 8 .…”

Percepções de gestores estaduais da saúde sobre o Contrato Organizativo da Ação Pública da Saúde no Ceará, Brasil

“…The Public Health Action Organizational Contract (Contrato Organizativo de Ação Públi-ca da Saúde -COAP), prescribed by Decree 7.508/2011 1 , provides the legal framework for the cooperative governance and management 2,3 of the Unified Health System (Sistema Único de Saúde -SUS), strengthening the logic behind Brazil's health care federalism 4,5 . The COAP is a plurilateral health agreement between federated entities that sets out responsibilities and functions that are defined through a process of integrated planning of health actions and services at Health Region (Regiões de Saúde -RS) level.…”