The Regulatory Complex for Health Care in the Federal District, Brazil and the challenge for integrating levels of health care

Batista, Sandro Rodrigues; Vilarins, Geisa Cristina Modesto; Lima, Mirlene Guedes de; Silveira, Talita Braga

doi:10.1590/1413-81232018246.08132019

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

ARTICLE • Ciênc. saúde colet. 24 (6) • June 2019 • https://doi.org/10.1590/1413-81232018246.08132019 copy

The Regulatory Complex for Health Care in the Federal District, Brazil and the challenge for integrating levels of health care

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The integration among levels of care is a continuous challenge even in consolidated and high performance health systems. The reform of public health system of Distrito Federal, based on the strengthening of primary health care associated to the reconfiguration of specialized attention (ambulatory and hospital) and of its of urgency and emergence network brought, as a challenge, the need for integration between these levels. Thus, became necessary to create an instrumentto perform the role of gatekeeper, leading to equanimous, transparent and safe access to specialized and hospital care. Thus, the Regulatory Complex in Health of Distrito Federal (CRDF) and its Regulatory Centers (CR) were created to carry out the regulatory process of access to care services, such as hospitalization, ambulatory care (procedures and specialized consultations), elective surgeries, complex procedures, sanitary transport, urgencies and transplants of patients of the Federal District and outside it. This article describes the process of the CRDF implementation and its CRs, aiming to reflect on the potential and challenges of its role as an instrument of integration among the levels of care.

Keywords
Health regulation; Health services accessibility; Health care networks; Coordination of care; Integrated care

Health Regulatory Complex (CRDF)
To guarantee access to public health services in an adequate manner, considering the principles of equity, universality and integrality;
To implement actions that focus on service providers, public and private, in order to guide an efficient, effective and efficacious production of health actions;
To encourage information use and qualification for the registration of users, establishments and health professionals on nationally based operational platforms;
To advise the boards of directors of the SHS/DF own hospitals, convened and hired ones, to adopt administrative and assistance measures necessary for the operation of the patient care network;
To control the availability of hospital beds, as well as the schedule of consultations, exams and procedures;
To standardize the regulatory protocols for the regulated areas after the agreement of the managers involved;
Establish standardsof referral and counter-referral between units, according to standardized flows and protocols, diagnosing, adapting and guiding the flows of care;
To permanently train the regulatory teams that will work in the health units;
To subsidize the actions of planning, control, evaluation, auditing in health and the processing of production information for decision-making;
To subsidize the agreed and integrated programming;
To organize specialized interregional and interstate reference flows.
Regulatory Centers (CR)
To absorb or integrate authorization processes, according to the previously established protocols;
To manage and monitor hospital bed occupation and health unit schedules;
To carry out thecontrol of the physical and financial boundaries of the services under regulation, according to the Integrated Agreed Programming (PPI);
To apply the risk classification criteria, prioritization of consultations and parameters of referrals, according to previous agreement between the actors involved;
To carry out the care process regulation, based on regulatory protocols.

Acronym	Regulatory Center	Scope and responsibilities	Subordination
CERIH	Hospitalization Regulation Center	Regulation of the hospital beds in health facilities linked to SUS, with regulation of ICU beds and general beds and clinical and surgical hospitalizations.	DIRAAH^#
CERA	Ambulatorial Regulation Center	Responsible for the regulationof patients' access to specialized consultations, exams, as well as other outpatient procedures.	DIRAAH^#
CERAC	Interstate and High Complexity Regulation Center	Regulation of patient access for patients who require high-complexity procedures outside their State of origin, such as Out-of-Home Treatment (OHT) and authorization for high-cost procedures performed within the SHS / DF network with the MoH.	DIRAAH^#
CERCE	Elective Surgery Regulation Center	Regulation of access to elective surgical procedures in the entire SHS / DF network.	DIRAAH^#
CERTS	Sanitary Transportation Regulation Center	Regulation of elective transportation of patients.	DIRAAH^#
CERU	Urgency Regulation Center	Regulation of access to Mobile Pre-Hospital and Hospital urgency and emergency services.	SAMU Board of Directors 192
CEITAP	Toxicological Information and Psychosocial Care Center	Regulation of urgencies and emergencies in the areas of toxicology, psychosocial care and violence. Referral in Clinical Toxicology in SUS.	SAMU Board of Directors 192
CET	State Transplant Center	Regulation of access to transplants in agreement with the National Transplant Center of the Ministry of Health.	CET^##

ABRASCO - Associação Brasileira de Saúde Coletiva Av. Brasil, 4036 - sala 700 Manguinhos, 21040-361 Rio de Janeiro RJ - Brazil, Tel.: +55 21 3882-9153 / 3882-9151 - Rio de Janeiro - RJ - Brazil
E-mail: cienciasaudecoletiva@fiocruz.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Collaborations

SR Batista worked on article conception and design, data research and organization, final writing of the manuscript, critical review, and manuscript approval for submission to publication. GCM Vilarins worked on article conception and design, in the final writing of the manuscript and its critical review. MG Lima worked on the final writing of the manuscript and its critical review. TB Silveira worked on data research and organization, final writing of the manuscript and its critical review.