Lay agency and healthcare: producing healthcare maps

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Cecilio, Luiz Carlos de Oliveira [UNIFESP]
Carapinheiro, Graca
Andreazza, Rosemarie [UNIFESP]
Medeiros de Souza, Ana Lucia [UNIFESP]
Garcia Andrade, Maria da Graca
Santiago, Silvia Maria
Meneses, Consuelo Sampaio [UNIFESP]
Reis, Denizi Oliveira [UNIFESP]
Araujo, Eliane Cardoso [UNIFESP]
Pinto, Nicanor Rodrigues da Silva [UNIFESP]
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This study aimed to characterize which regulatory logics (other than government regulation) result in healthcare output, using a two-stage qualitative study in two municipalities in the ABCD Paulista region in São Paulo State, Brazil. the first stage included interviews with strategic actors (managers and policymakers) and key health professionals. the second phase collected life histories from 18 individuals with high health-services utilization rates. An analysis of the researchers' involvement in the field allowed a better understanding of the narratives. Four regulatory systems were characterized (governmental, professional, clientelistic, and lay), indicating that regulation is a field in constant dispute, a social production. Users' action produces healthcare maps that reveal the existence of other possible health system arrangements, calling on us to test shared management of healthcare between health teams and users as a promising path to the urgent need to reinvent health.
Cadernos de Saude Publica. Rio de Janiero: Cadernos Saude Publica, v. 30, n. 7, p. 1502-1514, 2014.