Regionalization and access to healthcare in Brazilian states: historical and political-institutional conditioning factors/Regionalizacao e acesso a saude nos estados brasileiros: condicionantes historicos e politico-institucionais

• Published in: Ciência & saude coletiva 2012-11, Vol.17 (11), p.2881
• Main Authors: de Lima, Luciana Dias, Viana, Ana Luiza d'Avila, Machado, Cristiani Vieira, de Albuquerque, Mariana Vercesi, de Oliveira, Roberta Gondim, Iozzi, Fabiola Lana, Scatena, Joao Henrique Gurtler, Mello, Guilherme Arantes, Pereira, Adelyne Maria Mendes, Coelho, Ana Paula Santana
• Format: Article
• Language: Spanish
• ISSN: 1413-8123

This article examines the healthcare regionalization process in the Brazilian states in the period from 2007 to 2010, seeking to identify the conditions that favor or impede this process. Referential analysis of public policies and especially of historical institutionalism was used. Three dimensions sum up the conditioning factors of regionalization: context (historical-structural, political-institutional and conjunctural), directionality (ideology, object, actors, strategies and instruments) and regionalization features (institutionality and governance). The empirical research relied mainly on the analysis of official documents and interviews with key actors in 24 states. Distinct patterns of influence in the states were observed, with regionalization being marked by important gains in institutionality and governance in the period. Nevertheless, inherent difficulties of the contexts prejudice greater advances. There is a pressing need to broaden the territorial focus in government planning and to integrate sectorial policies for medium and long-term regional development in order to empower regionalization and to overcome obstacles to the access to healthcare services in Brazil. Key words Regionalization, Health policy, Unified Health System, Healthcare planning, Access to healthcare services O artigo aborda o processo de regionalizacao da saude nos estados brasileiros no periodo de 2007 a 2010, com o objetivo de identificar as condicoes que favorecem ou dificultam esse processo. Utilizou-se o referencial de analise de politicas publicas e, particularmente, do institucionalismo historico. Tres dimensoes sintetizam os condicionantes da regionalizacao: contexto (historico-estrutural, politico-institucional e conjuntural), direcionalidade (ideologia, objeto, atores, estrategias e instrumentos) e caracteristicas da regionalizacao (institucionalidade e governanca). A pesquisa empirica privilegiou a analise de documentos oficiais e entrevistas com atores-chave em 24 estados. Observaram-se combinacoes de fatores e padroes de influencia distintos nos estados, sendo a regionalizacao marcada por importantes ganhos de institucionalidade e governanca no periodo. Entretanto, dificuldades inerentes aos contextos comprometem maiores avancos. Ha necessidade de ampliar o enfoque territorial no planejamento governamental e integrar politicas setoriais ao desenvolvimento regional de medio e longo prazo para fortalecer a regionalizacao e superar entraves ao acesso aos servico