Regulation of access to specialized care in primary health care of Rio de Janeiro city: coordination or competition?

Abstract

There are studies that suggest the need for greater participation of primary health care (PHC) in care regulation. In the last decade, the city of Rio de Janeiro has decentralized outpatient regulation, giving PHC physicians a greater role in the regulatory process. This study, carried out between 2019 and 2020, analyzed the local process of regulating access to specialized care in PHC in this city, based on interviews with professionals and managers, document analysis and visits to services. The results were organized in the categories “PHC actors in regulation: roles, interactions and tools”, “PHC regulation expanding the coordination capacity of care” and “the practice of outpatient regulation under the urgency domain”. Comparative advantages of the decentralized arrangement for the interaction between requester and regulator were identified, partial expansion of the ability to coordinate care, competition for vacancies and inequities in access, in addition to the fragile interface between PHC and specialized care. Decentralization of regulation is promising, but requires attention to the work process in PHC and synergy with centralized regulatory processes, with the regionalized network as a backdrop.

Keywords:
Primary Health Care; Access to health services; Regulation in health