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RESUMO A pandemia provocada pela Covid-19 deu relevância à resiliência dos sistemas de saúde. Neste artigo, buscou-se explorar elementos que subsidiem uma agenda de pesquisa sobre resiliência para o Sistema Único de Saúde (SUS). A partir de revisão de escopo, analisou-se o desenvolvimento conceitual e metodológico da resiliência aplicada à pesquisa sobre sistemas de saúde em nível internacional e nacional, identificando quem são os grupos formuladores e o que propõem como modelos de análise. Em seguida, apresentou-se uma proposta de modelo de análise de resiliência adaptada às características do sistema de saúde brasileiro. O modelo embasou o apontamento de questões-chave a serem investigadas em pesquisas sobre a resiliência do SUS, a partir de quatro dimensões: governança e liderança, financiamento, recursos (força de trabalho, infraestrutura, medicamentos e tecnologias) e prestação de serviços. Ao final, discutem-se oportunidades e desafios para implementação de uma agenda de pesquisas de resiliência para o SUS.
ABSTRACT The COVID-19 pandemic highlighted the resilience of health systems. In this paper, we seek to explore elements to support a research agenda on resilience for the Unified Health System (SUS). First, based on a scoping review, we analyzed the conceptual and methodological development of resilience applied to health systems research both at international and national levels, identifying who the formulating groups are and what they propose as analytical frameworks. Then, we propose an analytical framework adapted for the Brazilian health system features. The framework underpinned the pointing out of critical issues to be investigated in research on SUS resilience, based on four dimensions: governance and leadership, financing, resources (workforce, infrastructure, medicines, and technologies), and service provision. Finally, we discuss opportunities and challenges for implementing a research agenda on resilience for the SUS.
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Background & objectives: User charges have been advocated on efficiency grounds despite the widespread criticism about their adverse effect on equity. We assessed the effect of user charges on inpatient hospitalizations rate and equity in Haryana State. Methods: The inpatient department (IPD) statistics of the public sector facilities in Yamuna Nagar district where user charges had been introduced were analysed and compared with Rohtak district which did not have user charge between 2000 and 2006. National Sample Survey data of Haryana for the 2004-2005 period were analyzed to compare utilization of public sector facilities for hospitalization, cost of hospitalization, and prevalence of catastrophic out-of-pocket (OOP) expenditure by income quintiles in three districts which had user charges and 17 districts of Haryana which did not levy user charges. Results: During 2000 and 2006, hospital admissions declined by 23.8 per cent in Yamuna Nagar district where user charges had been introduced compared to an almost static hospitalization rate in Rohtak district which did not have user charges (P<0.01). Public sector hospital utilization for inpatient services had a pro-rich (concentration index 0.144) distribution in the three districts with user charges and pro-poor (concentration index -0.047) in the 17 districts without user charges. Significantly higher prevalence of catastrophic health expenditure was observed in public sector institutions with user charges (48%) compared to those without user charges (35.4%) (P<0.001). Interpretation & conclusions: The findings of our study showed that user charges had a negative influence on hospitalizations in Haryana especially among the poor. Public policies for revenue generation should avoid user charges.
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Este relato tem por objetivo apresentar nossa experiência na utilização da História de Vida Focal como abordagem metodológica em pesquisa que buscou apreender o impacto da experiência de adoecimento e da busca do cuidado por usuários do Sistema Único de Saúde, apontando suas potencialidades na pesquisa em saúde e enfermagem e na prática avaliativa de serviços de saúde. A riqueza das narrativas fez emergir a subjetividade dos usuários, as interpretações e sentidos que os mesmos vão tecendo neste processo, possibilitando uma compreensão profunda dessa vivência que outras abordagens metodológicas dificilmente ofereceriam. Por permitir a composição dos Itinerários Terapêuticos empreendidos pelos usuários ao buscar a resolutividade para suas necessidades de saúde, a História de vida Focal demonstra grande potencialidade como estratégia metodológica privilegiada na prática avaliativa do cuidado em saúde na perspectiva de quem vivencia o adoecimento e a busca por cuidado, ou seja, o usuário e sua família.
The objective of this report is to show up our experience in using Focal Life Story strategy as a methodological attacking for researchs that tyed to apprehend the getting illness experience impact and the care search by the Brazilian Health Unique System users, showing its nursing and health research potentialities and at health services evalutive practices. The narratives richness came up the users subjectivity, as well as their interpretations and the meanings during this process, helping us at the deep comprehention of this experience, that others methodos probably would not offer us. The Focal Life Story allowed us to build the Therapeutics Itineraries tackled by the users when looking for resolutivity for their health necessities, and demonstrated a huge potencial as a privileged methodological strategy for the health services evalutive practices trough the view from who live the getting illness and the care search, that is, the health system user and his family.
Este relato tiene por objetivo presentar nuestra experiencia en la utilización de la Historia de vida Focal cómo abordaje metodológica en pesquisa que buscó aprehender lo impacto da experiencia del adolecemiento y de la busca de lo cuidado por usuarios de lo Sistema Único del Salud, apuntando sus potencialidades en la pesquisa en salud y enfermería y en la practica de la evaluación de los servicio del salud. La riqueza de las narrativas hizo emerger la subjetividad de los usuarios, las interpretaciones y sentidos que los mismos van tejiendo neste proceso, posibilitando una comprensión profunda de esta vivencia que otras abordajes metodológicas difícilmente ofrecerían. Por permitir la composición de los Intenerários Terapéuticos emprendidos por los usuarios al buscaren la resolutividad para sus necesidades del salud, la Historia de vida Focal demonstra grande posibilidad cómo estrategia metodológica privilegiada en la practica de la evaluación de lo cuidado en salud en la perspectiva de quien vivencia lo adolecemiento y la busca por cuidado, o sea, lo usuario y su familia.