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Healthcare network and access to specialist health services: ways to a integrated health system.


The principles of the Brazilian Health System are universality, integrality and equity. However, as in health systems around the world, provision of access to comprehensive care and coordination with primary health care is an important challenge. The health care system is fragmented, particularly in specialist care, with a tendency to high incorporation of technology, high costs and low results. The system is not effectively organized in regionalized networks and the regulatory systems are poorly organized. Access to specialized care, particularly doctor visits and laboratory tests, is a weakness of the system, with unsatisfied demand and access restriction. However, innovations are being observed in the organization of care networks, with focus on coordination of primary health care, identifying and approaching the knowledge of specialized care and improving continued and integrated care. The aim of this study is to analyze the organization of specialized care and outcomes for the system, identifying and proposing innovations in systems of care, particularly for chronic conditions. It is proposed a qualitative-quantitative methodology based on the complexity of the problem and the need to know and understand the key issues involved. The study will be conducted at two sites that are organized into integrated networks: the Southeast Region of Health of São Paulo city and Region of ABC of São Paulo State. An exploratory analysis with a review of the literature and a quantitative analysis of national data will be performed. Will also be conducted semi-structured interviews and focus groups with managers, professionals from primary and specialized care, and users of health services, using tracer cases. Processes of better communicate of specialists and primary care team and improvements in the integrated care will be identified. (AU)

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