Table 5 - uploaded by Marcelo Demarzo
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-Group of health Regions according to Socioeconomic and Health Conditioning Factors by provider in relation to hospital admissions
Source publication
Typology of health regions: structural determinants of regionalization in Brazil (Tipologia das regiões de saúde: condicionantes estruturais para a regionalização no Brazil): The socioeconomic development, supply and complexity of health actions and services in a regional context may be considered structural constraints to the success of the curren...
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Objectives:
to analyze the contributions of regionalization in North-Barretos and South-Barretos regions, focusing on political, structural and organizational changes.
Methods:
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Objectives:
Access to maternal and neonatal care services (MNCS) is an important goal of health policy in developing countries. In this study, we proposed a 3-level hierarchical location-allocation model to maximize the coverage of MNCS providers in Iran.
Methods:
First, the necessary criteria for designing an MNCS network were explored. Birth d...
This chapter explains the development of the Brazilian Unified Health System (SUS) within a hybrid development policy regime of neoliberal and new developmentalist policies. Focusing on three key dimensions for the development of health care in the Brazilian federative context— namely the regionalization of health care, stable and sufficient financ...
Citations
... A complexa regionalização dos serviços de saúde no Brasil é influenciada por diversos fatores, como o vasto território do país, a diversidade regional, as responsabilidades do Estado na saúde e a participação de múltiplos atores governamentais e não governamentais, públicos e privados, na prestação dos cuidados de saúde (Viana et al., 2015), além disso, as UTIs apresentam uma ampla diversidade em termos de localização, perfil de pacientes e disponibilidade de recursos, o que torna desafiante a implementação de medidas para melhorar a qualidade dos serviços (Bauman; Hyzy, 2014). ...
A imobilidade em pacientes críticos pode gerar complicações que afetam a recuperação, como a atrofia muscular e fraqueza esquelética, acarretando ônus tanto para os pacientes quanto para o Sistema Único de Saúde (SUS). As consequências da imobilidade podem persistir por até cinco anos após a alta hospitalar, caracterizando um problema de saúde pública, pois aumenta as comorbidades, a taxa de mortalidade e a frequência de necessidade de atendimento de alta complexidade, sobrecarregando tanto as famílias quanto o sistema de saúde brasileiro. Assim o objetivo deste estudo foi revisar a literatura narrativa sobre os benefícios da MP na UTI, visando aprimorar o entendimento desse tema, com potencial impacto positivo no cuidado aos pacientes, destacando a importância de políticas públicas aplicadas a essa área. Destaca-se que a fisioterapia e a Mobilização Precoce (MP) na Unidade de Terapia Intensiva (UTI) podem contribuir para mitigar os efeitos da imobilidade. No entanto, a implementação da mobilização precoce enfrenta desafios devido à falta de diretrizes claras e barreiras institucionais, o que pode resultar na redução da qualidade de vida, dificuldades na reintegração social e profissional do paciente, além de gerar custos financeiros significativos. O Custo Adicional e Utilização de Recursos após internações críticas afeta principalmente os jovens sem comorbidades, acarretando impactos econômicos e desafios para o sistema de saúde. O Sistema Único de Saúde (SUS) desempenha um papel crucial na mediação entre a demanda por fisioterapia e a oferta de serviços, embora enfrente obstáculos na promoção da saúde físico-funcional da população brasileira.
... The Unified Health System (SUS) relies on both instrumentsfederal aid and intergovernmental cooperationas means to decentralize provision of services and universalize free access to all population. Third, due to the limits of the expansion of social provision through "municipalization," national changes led to the adoption a regionalization model during 2000s, giving states the role of regional coordinators in some public policies, especially in the health care, education, and social assistance systems (da Silva, 2020; Menicucci et al., 2017;Viana et al., 2015). ...
... In 2011, a new national regulation gave other guidelines to the organization of the regions, including the creation of Intermanagers Commissions at the regional level. Studies show that states have been progressively implementing the Pact, but there are great differences on resources and technical capacities among them (Menicucci et al., 2017;Viana et al., 2015). ...
... The HARs were grouped as proposed by Viana et al. [22]: group 1, low socioeconomic status and low supply of health services; group 2, middle/high socioeconomic status and low supply of health services; group 3, middle socioeconomic status and intermediate supply of health services; group 4, high socioeconomic status and intermediate supply of health services; and group 5, high socioeconomic status and high supply of health services. The classification criteria of each macroregion were extracted from the website "Region and Networks -Path of universalization of health in Brazil" [23]. ...
Background:
The organisation and systematisation of health actions and services are essential to ensure patient safety and the effectiveness and efficiency of cancer care. The objective of this study was to analyse the structure of cancer care envisaged in Brazilian norms, describe the types of accreditations of cancer services and their geographic distribution, and determine the planning and evaluation parameters used to qualify the health units that provide cancer care in Brazil.
Methods:
This observational study identified the current organisation of cancer care and other health services that are accredited by Brazil's national health system (SUS) for cancer treatment as of February 2017. The following information was collected from the current norms and the National Registry of Health Establishments: geographic location, type of accreditation, type of care, and hospital classification according to annual data of the number of cancer surgeries. The adequacy of the number of licensed units relative to population size was assessed. The analysis considered the facilitative or restrictive nature of policies based on the available rules and resources.
Results:
The analysis of the norms indicated that these documents serve as structuring rules and resources for developing and implementing cancer care policies in Brazil. A total of 299 high-complexity oncology services were identified in facilities located in 173 (3.1%) municipalities. In some states, there were no authorised services in radiotherapy, paediatric oncology and/or haematology-oncology. There was a significant deficit in accredited oncology services.
Conclusions:
The parameters that have been used to assess the need for accredited cancer services in Brazil are widely questioned because the best basis of calculation is the incidence of cancer or disease burden rather than population size. The results indicate that the availability of cancer services is insufficient and the organisation of the cancer care network needs to be improved in Brazil.
... First, we observed a downward temporal trend in the COPD mortality rates in the macro-regions with higher socioeconomic indices. (22,23) Second, we observed a downward temporal trend in the in-hospital morbidity outcomes (number of hospitalizations, length of hospital stay, and hospital expenses) and mortality indicators in all regions, with a far more pronounced decrease in the regions exhibiting more favorable socioeconomic conditions. In Brazil, the COPD age-adjusted mortality rate presented a significant decrease in both genders. ...
Objective:
To examine the trends in overall COPD mortality, as well as trends in in-hospital morbidity and mortality due to COPD, in Brazil, and to validate predictive models.
Methods:
This was a population-based study with a time-series analysis of cause-specific morbidity and mortality data for individuals ≥ 40 years of age, obtained from national health information systems for the 2000-2016 period. Morbidity and mortality rates, stratified by gender and age group, were calculated for the same period. We used regression analyses to examine the temporal trends and double exponential smoothing in our analysis of the predictive models for 2017.
Results:
Over the study period, COPD mortality rates trended downward in Brazil. For both genders, there was a downward trend in the southern, southeastern, and central-western regions. In-hospital morbidity rates declined in all regions, more so in the south and southeast. There were significant changes in the number of hospitalizations, length of hospital stay, and hospital expenses. The predictive models for 2017 showed error rates below 9% and were therefore validated.
Conclusions:
In Brazil, COPD age-adjusted mortality rates have declined in regions with higher socioeconomic indices, where there has been an even sharper decrease in all in-hospital morbidity and mortality variables. In addition to factors such as better treatment adherence and reduced smoking rates, socioeconomic factors appear to be involved in controlling COPD morbidity and mortality. The predictive models estimated here might also facilitate decision making and the planning of health policies aimed at treating COPD.
... In order to select the cases, we considered all the municipalities that had, in their territory, chemotherapy services for the treatment of patients with breast cancer 9 . The cases were characterized by the geographic macro-region and the type of health region (HR) in which they were inserted (groups 1 to 5) 10 . The type of HR employed is based on the analysis of two dimensions -the socioeconomic situation and the supply and complexity of health services. ...
This study, based on the Giddens' Structuration Theory, aimed to analyze organization and pharmaceutical services practices for oncology care in five brazilian municipalities by a multiple-case study design, having breast cancer as a marker condition. Oncology care-certified facilities were established as analysis sub-units. In-depth interviews were conducted with ten managers and fifteen health professionals. Research strategy also involved document analysis and direct observation of practices. Results were analyzed according to four main themes: organizational structure, financing, technologies and work process. We found little interaction of pharmaceutical services with levels of care, structural problems within facilities, insufficient funding, belated technology assessment and technology adoption, and shortfalls in work processes. These aspects contribute to precarious functioning of the cancer-care system.
... Com o intuito de selecionar os casos, foram considerados todos os municípios que tinham, em seu território, serviços de quimioterapia para tratamento de pacientes com câncer de mama 9 . Os casos foram caracterizados quanto à macrorregião geográfica e o tipo de região de saúde (RS) em que estavam inseridos (grupos 1 ao 5) 10 . A tipologia de RS empregada se baseia na análise de duas dimensões -situação socioeconômica e oferta e complexidade dos serviços de saúde. ...
Este artigo, fundamentado na Teoria da Estruturação de Giddens, buscou analisar a organização e as práticas da assistência farmacêutica em oncologia em cinco municípios brasileiros por meio de um estudo de casos múltiplos, tendo o câncer de mama como condição marcadora. A subunidade de análise foram as unidades habilitadas de atenção oncológica. Foram entrevistados dez gestores e quinze profissionais de saúde. Complementarmente, foram considerados documentos e dados da observação direta da ação dos profissionais. Os resultados foram analisados segundo quatro eixos: estrutura organizacional, financiamento, tecnologias e processos de trabalho. Destacaram-se: a baixa articulação das ações de assistência farmacêutica realizadas entre os níveis de atenção à saúde, problemas estruturais nos serviços, insuficiência de financiamento, atrasos nos processos de avaliação e incorporação de tecnologias, e falhas nos processos de trabalho. Os aspectos destacados contribuem para a precariedade do funcionamento do sistema.
... Vários autores (Albuquerque, 2014;Viana et al., 2015;Viana et al., 2010) referem que, no Brasil, o direito universal à saúde, portanto o SUS, não se efetiva igualmente em todos os lugares, por se concretizar de maneira incompleta e seletiva no território em geral, seguindo as tendências regionais de concentração e escassez populacional, econômica e das modernizações técnicas, científicas e de informação, que caracterizam o meio geográfico. Pois os lugares e regiões mais empobrecidas e menos atrativos para o grande capital são também aqueles que apresentam menor capacidade de investimentos na saúde, maiores dificuldades de atração e fixação de profissionais de saúde, menor capacidade de oferta assistencial pública e privada e maiores dificuldades relacionadas à gestão, ao financiamento e ao planejamento do SUS. ...
RESUMO Objetivo: Analisar quais as variáveis socioeconômicas, estruturais e demográficas possuem maior associação com a produção e os gastos ambulatoriais de média complexidade no estado de Minas Gerais no ano de 2014. Métodos: Estudo ecológico, analítico observacional em uma população de 853 municípios do estado de Minas Gerais agregados por 77 Comissões Intergestoras Regionais (CIRs). Foram realizadas análises descritivas, bivariada e multivariada, entre o gasto com a produção e variáveis explicativas sociodemográficas e econômicas, cobertura da estratégia saúde da família, número de médicos especialistas e de atenção básica, e oferta (equipamentos) dos serviços em média complexidade. Resultados: A caracterização socioeconômica, demográfica e de estrutura dos serviços de saúde das CIRs indicou heterogeneidade nessas variáveis. Foi evidenciada corre-lação positiva entre a produção e o gasto per capita ambulatorial em média complexidade com as variáveis: produto interno bruto (PIB), renda média domiciliar per capita, índice de desenvolvimento humano municipal (IDHM), condição de habitação, sexo feminino e médicos especialistas e de aten-ção básica. Evidenciaram-se ainda correlações negativas com as variáveis: taxa de analfabetismo e cobertura da estratégia saúde da família. Na regressão linear múltipla, a variável condição de habi-tação apresentou maior valor preditivo em relação à produção per capita em média complexidade e as variáveis "médicos especialistas", "condições de habitação" e "equipamento RX" mostraram maior valor preditivo para gasto per capita em média complexidade. Conclusão: Os resultados fornecem evidências de que a infraestrutura e a condição socioeconômica das CIRs estão determinando a maior produção e gastos ambulatoriais de média complexidade, pois regiões com menor infraes-trutura e condição socioeconômica tendem a gastar menos. ABSTRACT Objective: To analyze which socioeconomic, structural and demographic variables have a more relevant association with the production and outpatient expenses of medium complexity in the state of Minas Gerais during 2014. Methods: Ecological, observational analytical study with a population of 853 municipalities in the state of Minas Gerais aggregated by 77 Regional Interactive Commis-Recebido em: 07/08/2018. Aprovado para publicação em: 11/01/2019.
... For this reason, it becomes essential to call off the concentration of teaching institutions and the investments in urban centers, and to promote the development of public, regional and integrated policies in order to promote the organization of regional health systems based on the principles of SUS. 28 It is necessary to look at the needs that arise everyday and, from there, draw up curriculums and propose internships to be completed in several regional areas, in a logic training based on the health care system, promoting the future professional the understanding of the necessity of regional integration. 27 ...
Objectives:
to identify on the one hand whether there has been any changes in the nurse training in Brazil and on the other if regionalizing health incurred interference in this process.
Methods:
an exploratory research of a multiple case study in a qualitative approach developed between November 2015 and March 2017, in seven regions in Brazil. The data were collected by in-depth interviews with 16 administrators of the undergraduate courses in nursing and by documentary analysis of the Projetos Políticos Pedagógicos (Political Pedagogical Projects). Content analysis was undertaken by having the theoretical references of the Diretrizes Curriculares Nacionais (National Curriculum Guidelines).
Results:
varied profiles of undergraduates were observed with higher tendency for the basic level in health practice or for hospital level with competencies in health care that is still fragmented and not interdisciplinary. The curricular structure of the courses focuses on isolated disciplines with little or no interdisciplinary integration and the pedagogical model is based on traditional teaching-learning strategies and additional evaluation process. There were no differences in health among the regions.
Conclusions:
it is necessary in concomitance with the changes that are required in the field of training to undertake efforts in the development of health units and training institutions, which has already proven to be a factor of professional retention and regional development.
Background:
As of December 31, 2020, Brazil had the second-highest burden of COVID-19 worldwide. Given the absence of federal government coordination, it was up to the local governments to maintain healthcare provision for non-COVID health issues. In this descriptive study, we aimed to discuss the SUS functionality and resilience, describing the impact of the pandemic on non-COVID health services delivery while considering the regional inequalities of the allocation of financing health system, health infrastructure and health workforce.
Methods:
We used input-output framework based on the World Health Organization (WHO) Health System Building Blocks to estimate health system functionality and resilience. An ecological assessment was designed to calculated mean relative changes to compare the first year of the pandemic in Brazil with the previous one. All data used in this study were anonymized and made available by the Brazilian Ministry of Health. Input indicators were categorized in health system financing (federal funding received as well as expenditure of both state and city governments), health system's infrastructure (hospital beds) and health workforce (healthcare workers positions). Output indicators were categorized into nine different groups of service delivery procedures. To explore the relationship between the variation in procedures with socioeconomic conditions, we used the Socioeconomic Vulnerability Index (SVI).
Findings:
State governments had a 38·6% increase in federal transfers, while municipal governments had a 33·9% increase. The increase of ICU beds reached its peak in the third quarter of 2020, averaging 72·1% by the end of the year. The country also saw an increase in jobs for registered nurses (13·6%), nurse assistants (8·5%), physiotherapists (7·9%), and medical doctors (4·9%). All procedures underwent expressive reduction: Screenings (-42·6%); Diagnostic procedures (-28·9%); Physician appointments (-42·5%); Low and medium complexity surgeries (-59·7%); High complexity surgeries (-27·9%); Transplants (-44·7%); Treatments and clinical procedures due to injuries of external causes (-19·1%); Irrepressible procedures (-8·5%); and Childbirths (-12·6%). The most significant drop in procedures happened in the first quarter of the pandemic, followed by progressive increase; most regions had not yet recovered by the end of 2020. State-level changes in numbers of procedures point towards a negative trend with SVI.
Interpretation:
The Brazilian Government did not consider that socioeconomically vulnerable states were at a higher risk of being impacted by the overburden of the health system caused by the COVID-19, which resulted in poorer health system functionality for those vulnerable states. The lack of proper planning to improve health system resilience resulted in the decrease of a quarter of the amount of healthcare procedures increasing the already existing health disparities in the country.
Funding:
MCTIC/CNPQ/FNDCT/MS/SCTIE/DECIT No 07/2020.
