The remuneration logic of Specialized Outpatient Care leading to the fragmentation of care

The article reflects on the influences of the form of remuneration for the Specialized Outpatient Care (AAE) in the Unified Health System (SUS) on the health care model and presents some strategies adopted to address the fragmentation of care. It is a qualitative study that uses empirical material produced from two surveys carried out in Municipal Health Departments and the State Health Department of the State of São Paulo. The results indicate that the remuneration logic of AAE, based on payment per procedure, leads to the fragmentation of care and the starting point is not the user’s needs. It also indicates that the management contract model can also fragment care, especially when it only evaluates the efficiency of the contracted provider and not the care offered. At the same time, the experiences analyzed demonstrate the organization of regulatory devices for networked care. It is concluded that it is necessary to consider remuneration models that encourage the use of light and relational technologies, whose performance assessment is consistent with the principles and guidelines of the SUS.

KEYWORDS
Health services administration; Secondary care; Health care coordination and monitoring; Comprehensive health care; Health system financing