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Logic multiplicity in the construction of health care networks at the Brazilian SUS: beyond governmental regulation on access and use of health services

Abstract

One of the main issues derived from the deployment of the Brazilian Health Service (SUS) is the apparently unattainable shortfall between the supply and demand of health care services in all levels of the system. Even considering that all explanations are multiple and complex, the current paper starts from two main presuppositions: a) the insufficiencies found in the regulation of the access to health services contribute to increase the gap between supply and demand; b) the formal regulation exerted by the managers interacts with more informal as well as rather active ‘regulatory’ ( or ‘counter-regulatory’) ways performed by non-governmental actors, particularly the users - through their ‘therapeutical itineraries’ - and the physicians - building informal health care networks by means of personal professional contacts. Qualitative research will be performed in the cities of São Bernardo do Campo and Diadema to describe the qualities of the multiple regulatory rationale concerning the access and the use of health services - either in its formal dimension, which stems from government responsibility, or in its informal dimension, to identify the dynamic relations established between them; and to subsidize the formulation of regulatory processes made by the local health care manager that incorporate the leading role played by the several local actors, in a creative as well as solidary way, within the global regulation process. The research will be developed in two stages. The former is ‘field characterization’, in which the following methodological procedures will be developed: a) construction of ‘focused biographies’ concerning patients selected in several points of the health care system where they undergo situations of vulnerability and a high level of health service utilization is found. Half of those patients shall be covered by any private health insurance plan; b) interviews with medical doctors who play a role in the system; c) interviews with operators of regulation and medical unit managers. The latter is ‘partaking’, where meetings with local technicians will be held towards the discussion and appropriateness of the findings resulting from the study, in addition to the formulation of regulatory mechanisms that attempt to envisage the manifold reasons for regulation. The research shall be performed in a partnership with the two local managers, the regional entity from the State Health Department and the Centro de Investigações Estudos em Sociologia, (Instituto Superior de Ciências do Trabalho e da Empresa / Instituto Universitário de Lisboa) (CIES-ISCTE/IUL), from Lisbon (Portugal) and Universidade Estadual de Campinas, through the Preventive Health Department (Departamento de Medicina Preventiva e Social - DMPS). (AU)