A territorialidade da alta complexidade na Região Metropolitana de Belém, Brasil: a saúde especializada é subsidiada pelo SUS? / Territorial dynamics of highly complex health services in the Belém Metropolitan Region, Brazil: is specialized health care subsidized by the SUS?

Resumo O artigo apresenta uma análise sobre a atuação da rede de atenção especializada do SUS, com a delimitação dos serviços de média e de alta complexidade da rede hospitalar dos municípios que compõem a Região Metropolitana de Belém. A discussão se fundamenta na revisão dos dados secundários captados na plataforma do DATASUS e disponibilizados no Cadastro Nacional de Estabelecimentos de Saúde do Brasil (CNES) até janeiro de 2022. Constatou-se que a territorialidade da alta complexidade é formada majoritariamente pela rede privada, contudo a capacidade de atendimento da rede SUS sobrepôs à oferta direcionada ao atendimento não universal, em razão da ampla reserva de serviços privados ao convênio SUS, na qual os hospitais filantrópicos apresentaram maior disposição à demanda universal. Em contrapartida, a ampla presença do Estado nos serviços de alta complexidade não deve ser pensada como uma cobertura universal, devido ao fato de as formas de acesso a esses serviços apresentarem filtros de natureza jurídico-institucional, ou, em outras palavras, o que o SUS denomina de hospitais de portas abertas ou fechadas.

Abstract This article presents an analysis of the territorial dynamics of the specialized healthcare network, focusing on medium and high complexity care in hospitals in the municipalities that make up the Belém Metropolitan Region. The analysis is based on secondary data from DATASUS available on the National Health Facility Registry (CNES) up to January 2022. The findings show that the private network accounts for the largest proportion of services in the region; however, the service capacity of the SUS is greater than that of the private sector due to the large volume of services outsourced to private facilities via public-private partnerships, with philanthropic hospitals allocating the largest proportion of services to public patients. This should not be confused with universal coverage, as public patient access to private services may be restricted by legal and institutional barriers depending on the form of access (open-door or closed-door).

Allocation of village-level health resources in Huairou District of Beijing from the perspective of health geography / 中华医院管理杂志

Objective:To analyze the physical geography and social and economic geography of Huairou District, Beijing, from the perspective of health geography and based on the science of health policy, and study the implementation effects and existing problems of village-level health resource allocation policy based on household registration system and population number, then put forward relevant countermeasures.Methods:From December 2020 to May 2021, 14 rural townships in Huairou district of Beijing were investigated on the basis of literature review, on the basis of information saturation, through typical case analysis, semi-structured interview and other methods. According to the distribution of physical geography and social economic geography, 15 administrative villages of 3 townships were selected to carry out field observation and in-depth interviews with key insiders on the basic information of village clinics and rural doctors, basic medical and health services, management system and operation mechanism.Results:The characteristics of geographical environment, population change and population density of village-level health institutions in Huairou district made the current situation of village-level health resources allocation highlight the current situation of insufficient policy coordination and supervision, and showed the reality of unbalanced distribution of village-level health institutions. There was a big gap between the geographical distribution of villager health institutions and the allocation of health human resources and the health needs of villagers, and the current situation was worrying. The lack of analysis of health geographical factors in the policy formulation and implementation was an important factor.Conclusions:To realize village-level health allocation, it is necessary to fully consider health geographic factors, break institutional boundaries through policy coordination and differentiation, and gradually optimize village-level health resource allocation starting from optimizing the layout of village-level health institutions.

Salud y geografía / Health and Geography

El texto alude al contenido de la geografía como ciencia, sus espacios y de la existencia en la superficie del planeta del animal humano. Analiza como este animal humano, el hombre, a pesar de su inteligencia realiza prácticas no inteligentes entre ellas, guerras, terrorismo, adicciones y su acción depredadora y contaminante. Estas últimas han sido objeto de estudio por la geografía, que ha avanzado hasta desarrollar la geografía humana y la geografía de la salud. Destaca la existencia y vigencia de esta última, que se ocupa, entre otros, de los cambios en los patrones de fecundidad, migraciones, urbanismo patogénico, barrios insalubres, carencia de agua potable, inseguridad alimentaria y vial, todos riesgos y agresiones a la salud que el biologicista ve convertirse en epidemias de obesidad, estrés, violencia y desigualdades. En la preparación de los salubristas, debe incluirse el estudio de estos problemas desde la visión más amplia que proporciona la geografía de la salud(AU)

The text refers to the contents of Geography as a science, its areas and the existence in the planet of the human animal. It analyzes how this human animal (man), although its intelligence carry out non smart things as wars, terrorism, addictions with their consequent predatory and pollutant actions. These last have been studied by Geography as a science developing specialties as Human Geography and Health's Geography. It is remarkable the existence and validity of Health's Geography that deals with the changes in fertility patterns, migrations, pathogenic urbanism, unhealthy neighborhoods, lack of drinkable water, food and road insecurity, among others that represent risks and aggressions to health and that the specialist in this field analyzes as potential outbreaks of obesity, stress, violence and inequality. In the training of health workers should be included the study of this problems from the wide view that Health's Geography offers(AU)

Desarrollo de la geografía médica o de la salud en Cuba / Development of medical or health geography in Cuba

A lo largo de la historia la geografía y la medicina han compartido sus espacios, pues dentro de sus objetivos de estudio se encuentra el hombre como pilar esencial en ambas disciplinas. Analizar el desarrollo de la geografía médica o de la salud en Cuba es el propósito de este artículo. El trabajo se estructura en tres partes fundamentales: la primera aborda el surgimiento de la geografía médica o geografía de la salud, la segunda trata de la incorporación y desarrollo de los Sistemas de Información Geográfica y la tercera hace referencia a algunos de los estudios realizados sobre esta temática en Cuba. Los resultados palpables que se han consolidado a lo largo de los años demuestran que la geografía médica es una rama de la geografía que ha cobrado mayor fuerza con el surgimiento de los Sistemas de Información Geográfica. En Cuba la geografía médica fue favorablemente aceptada y un ejemplo de ello es la incorporación de geógrafos en el sistema nacional de salud, fundamentalmente en el área de higiene y epidemiología. Existen numerosos trabajos que abordan el análisis espacial dentro de la relación salud/enfermedad y causa /efecto que generan nuevos conocimientos de la situación actual de salud, facilitando la toma de decisiones a diferentes niveles(AU)

Throughout history, geography and medicine have had common objects of study, for man is the essential pillar in both disciplines. The present review is aimed at analyzing the development of medical or health geography in Cuba. The paper consists of three main sections. The first one approaches the emergence of medical or health geography, the second deals with the incorporation and development of Geographic Information Systems, and the third refers to some studies conducted on the subject in Cuba. The palpable results obtained throughout the years show that medical geography is a branch of geography which has gained greater strength with the emergence of Geographic Information Systems. Medical geography was welcomed in Cuba, an example of which is the incorporation of geographers into the national health system, mainly in the area of hygiene and epidemiology. Numerous studies address spatial analysis within health / disease and cause / effect relationships, generating new knowledge about the current health situation and facilitating decision making on various levels(AU)

Análise espacial da mortalidade por causas externas no município de Maringá, Estado do Paraná, 1999 a 2001 / Spatial analysis of mortality from outside causes in the city of Maringá, 1999-2001

O objetivo deste estudo é analisar a distribuição espacial da mortalidade porcausas externas (acidentes de trânsito, homicídios, suicídios, quedas, afogamentos e outras causas externas) no Município de Maringá, no período de 1999 a 2001. A representação espacial da mortalidade por causas externas levou em consideração as zonas censitárias e as características socioeconômicas destas. Para isso, foram utilizados o programa ArcView 3.0 e as proposições da semiologia gráfica para elaboração dos mapas temáticos. Os resultados desta análise evidenciaram desigualdades na mortalidade por causas violentas nos três anos de estudo, não fazendo qualquer distinção entre a infraestrutura urbana e as características socioeconômicas das vítimas. Dessa forma, é necessário que a cidade seja revista como um espaço de gestão planejada na perspectiva de uma vida saudável para todos, com objetivosconcretos de redução das iniquidades sociais. Portanto, é imprescindível que a promoção da saúde incorpore estratégias de alteração no perfil de riscos da morbimortalidade das causasexternas, por intermédio da formulação das políticas públicas.

The goal of this study is the analysis of the spatial distribution of mortality from external causes (traffic accidents, homicides, suicides, falls, drownings andother external causes) in the city of Maringá, between 1999 and 2001. The special representation of the mortality due to external causes considered the census zones and their socioeconomic characteristics. For this, the ArcView 3.0 software program was used, as wellas the propositions of the semiology of graphics for the elaboration of thematic maps. The results of this analysis showed inequalities in the mortality due to violent causes during the three years of the study, without distinction among the urban infrastructure and the socialeconomic characteristics of the victims. Therefore, it becomes necessary that the city be reviewed as a planned managed space for a healthier life for all, with objective goals to reduce social iniquities. However, it is essential that the promotion of health add strategiesfor changes in the profile of mortality risks due to external causes, through the formulation of public policies.