Os médicos e a regulação do acesso aos serviços de Saúde: o agir comunicativo como estratégia governamental em Diadema/SP (2008 a 2011)
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Data
2013
Autores
Albieri, Flavius Augusto Olivetti [UNIFESP]
Orientadores
Cecílio, Luiz Carlos de Oliveira [UNIFESP]
Tipo
Dissertação de mestrado
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No Sistema Unico de Saúde (SUS) do Brasil, a regulacao do acesso aos servicos de Saúde busca superar a diferenca entre a oferta e a demanda por servicos de Saúde. Tendo em vista as diretrizes de universalidade, integralidade e equidade previstos no SUS, a equipe gestora da Saúde do municipio de Diadema/SP u cidade com mais de 390 mil habitantes e que tem investido mais de 30% do seu orcamento anual em Saúde nos ultimos 10 anos u realizou, entre 2008 a 2011, 72 oficinas tematicas sobre a regulacao do acesso envolvendo gestores e cerca de 700 profissionais, principalmente medicos, com o objetivo de construir relacoes mais proximas e negociadas entre a Gestão e as equipes de Saúde, sempre na perspectiva de melhorar o cuidado prestado. Apos os ciclos de oficina, pode-se identificar a reducao de 18% de encaminhamentos para consultas medicas especializadas, e de 9% em exames de apoio diagnostico em relacao aos anos anteriores as oficinas. Este estudo buscou analisar qualitativamente, a partir de grupos focais com participantes das oficinas (medicos, gerentes das unidades basicas de Saúde e medicos reguladores), as possiveis contribuicoes da estrategia para o aprimoramento da regulacao no municipio, em particular o fortalecimento de processos micro regulatorios locais. Os dados dos diferentes grupos focais foram cruzados com o objetivo de produzir um dialogo entre os varios atores institucionais envolvidos com regulacao. O estudo mostra como o ciclo de oficinas foi vivenciado e apreendido de modos bastante diferenciados pelos varios participantes, resultando em transformacoes nos processos de trabalho locais que guardam ritmos e iniciativas bastante diferentes entre si, aportando, desse modo, elementos importantes a serem considerados nas propostas governamentais de descentralizacao do processo regulatorio
In the Unified Health System (SUS) in Brazil, the regulation of access to health services seeks to overcome the gap between supply and demand for health services. Keeping in view the guidelines of universality, comprehensiveness and equity provided by the SUS, the health management team of Diadema/SP – a city with more than 390.000 inhabitants and that has been investing more than 30% of its annual budget in health over the last 10 years– conducted between 2008 and 2011, 72 workshops about regulation of access to health services, involving managers and approximately 700 professionals, mainly doctors, in order to build closer and negotiated relationships between management and health teams, always aiming to improve the care provided. After the workshop’s cycles, we could identify 18% reduction on specialized medical consultations and 9% decrease in diagnosis support exams comparing to the years before the workshops. This study attempted to analyze qualitatively, from focus groups with workshop participants (doctors, managers of primary health care services and regulator´s physicians), contributions possible of strategy to improvement of regulation in the city, in particular the strengthening of micro regulatory local processes. Data from different focus groups were crossed with the goal to producing a dialogue between the various institutional actors involved in regulation. The study shows how the workshop´s cycles was apprehended and experienced in very different ways by various participants, resulting in changes in work processes that keep local initiatives and rhythms quite different, providing thus important elements to be considered in governmental proposals of decentralization regulatory process.
In the Unified Health System (SUS) in Brazil, the regulation of access to health services seeks to overcome the gap between supply and demand for health services. Keeping in view the guidelines of universality, comprehensiveness and equity provided by the SUS, the health management team of Diadema/SP – a city with more than 390.000 inhabitants and that has been investing more than 30% of its annual budget in health over the last 10 years– conducted between 2008 and 2011, 72 workshops about regulation of access to health services, involving managers and approximately 700 professionals, mainly doctors, in order to build closer and negotiated relationships between management and health teams, always aiming to improve the care provided. After the workshop’s cycles, we could identify 18% reduction on specialized medical consultations and 9% decrease in diagnosis support exams comparing to the years before the workshops. This study attempted to analyze qualitatively, from focus groups with workshop participants (doctors, managers of primary health care services and regulator´s physicians), contributions possible of strategy to improvement of regulation in the city, in particular the strengthening of micro regulatory local processes. Data from different focus groups were crossed with the goal to producing a dialogue between the various institutional actors involved in regulation. The study shows how the workshop´s cycles was apprehended and experienced in very different ways by various participants, resulting in changes in work processes that keep local initiatives and rhythms quite different, providing thus important elements to be considered in governmental proposals of decentralization regulatory process.
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Citação
ALBIERI, Flavius Augusto Olivetti. Os médicos e a regulação do acesso aos serviços de Saúde: o agir comunicativo como estratégia governamental em Diadema/SP (2008 a 2011). Dissertação (Mestrado em Ciências) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2013.