ABSTRACT
Resumo O objetivo é analisar a organização e oferta de atenção especializada (AE) e transporte sanitário nas Policlínicas Regionais da Bahia, via Consórcios Interfederativos de Saúde. Foi realizado estudo de caso em uma Policlínica, com abordagem qualitativa, a partir de entrevistas com atores municipais e estaduais. Buscou-se identificar elementos que caracterizam um modelo de AE integrado às Redes de Atenção à Saúde. Entre os avanços identifica-se ampliação da oferta de AE; garantia de escopo, qualidade e fixação de profissionais; provisão de transporte sanitário; monitoramento da prestação da AE; e avanços na regulação por sistema informatizado. Representam desafios: adequação do planejamento da AE à realidade locorregional; incentivo à coordenação do cuidado pela Atenção Primária à Saúde (APS) e à aproximação entre profissionais da AE e APS; institucionalização da contrarreferência, relação com instâncias de participação social; e incentivo às funções de matriciamento, Educação Permanente, integração ensino-serviço e pesquisa. Considera-se o arranjo das Policlínicas Regionais, mais afeito à integração às Redes de Atenção à Saúde, em que pese os desafios intrínsecos à AE e ao necessário fortalecimento da APS para que possa assumir a condução do sistema.
Abstract The aim of this study was to analyze the organization and provision of specialized care (SC) and health transport in regional polyclinics in the state of Bahia, Brazil. We conducted a qualitative exploratory single case study of a polyclinic based on semi-structured interviews with key informants in municipal and state health services. We sought to identify elements that characterize network-based models of SC. A number of advances were identified, including: an increase in the provision of SC and the scope and quality of services; effective retention of health professionals; provision of health transport; monitoring of SC; and improvements in the regulation of access to care through the use of computerized systems. The following challenges were observed: tailoring SC planning to regional health needs; the promotion of care coordination by Primary Health Care (PHC); the development of strategies to improve communication between SC and PHC professionals; institutionalization of counter-referral; engagement between the polyclinic and spaces for citizen participation; and fostering matrix support, permanent education, teaching-service integration, and research. Despite the intrinsic challenges of SC and the need to strengthen the central role of PHC, the regional polyclinic arrangement is better suited to the integration of the health care networks.
ABSTRACT
Objective:After examining the changes in medical expenses and flows of hospitalized patients with-in and outside the county under the New Rural Cooperative Medical Scheme ( NRCMS ) before and after the imple-mentation of health care alliance reform, this paper analyzes the impacts of health care alliance reform on the visiting rate of NRCMS patients within the county and explores their causes and channels. Methods:This paper uses the hos-pitalization data of NRCMS patients in 2013 and 2014 collected from Huangzhong county Qinghai province and inter-views with key informants and analyzes the hospitalization expenses, visiting flows and other indicators of patients. Results:After starting health care alliance reform, the total number of hospitalized patients to seek treatment outside the county decreased by 6 . 38%, the total hospitalization expenses to seek treatment outside the county decreased by 22 . 13%, and the hospitalization expenses per inpatient day to seek treatment within and outside the county increased by 14. 41% and 20. 69% respectively. Conclusions: By improving service capabilities of township health centers and increasing synergies between county-township-village health institutions, the county health care alliance reform has suc-cessfully enhanced the service capabilities of health care systems in the whole county and reasonably helped patients with common diseases to be hospitalized outside the county and frequently hospitalized people to return back to the county.