Configuration of Health Care Networks in the SUS: analysis based on primary and hospital care components

Chaves, Lenir Aparecida; Andrade, Eli Iola Gurgel; Santos, Alaneir de Fátima dos

doi:10.1590/1413-81232024296.18392022EN

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

FREE THEMES • Ciênc. saúde coletiva 29 (06) • June 2024 • https://doi.org/10.1590/1413-81232024296.18392022EN copy

Configuration of Health Care Networks in the SUS: analysis based on primary and hospital care components

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This study seeks to point out the different configurations of Health Care Networks in primary care (AB) and Hospital Care (AH), dimensioned based on coverage, quality, and resolvability characteristics in health macro-regions. Cross-sectional study used the cluster analysis and segmented 103 macro-regions into different profiles of coverage, quality and resolubility: group 1 (high coverage/AB and medium/AH; low quality AB-AH with high resolubility); group 2 (high coverage/AB and low/AH; low quality AB-AH with medium resolubility) and group 3 (high coverage/AB and medium/AH; high quality AB-AH with high resolubility). Coverage in AB was classified as high for 100% of the Brazilian population and in AH low to 9.70% and medium to 90.29%. Quality/AB-AH is low for 58.54% and high for 41.15%. Resolubility is high for 90.29% and medium for 9.70%. In Brazil, there is expansion of coverage with low quality/AB; shortage of hospital beds and low quality/HA with high resolution. However, in the Southeast and South, high AB-AH quality prevails. The structuring of health networks is still characterized by low resolution, demanding incentives for the governance of inter-federal arrangements.

Key words:
Primary health care; Tertiary health care; Health services coverage; Quality; access; and evaluation of health care; Regionalization of health

Object	Characteristics	Variable	Calculation method	Indicator
Primary care	EqAB Certification Note in the 2nd cycle of PMAQ-AB.	Quality Component/AB.	Average EqAB certification score by health macro-region.	Average quality/AB component by health macro-region.
Primary care	Population coverage of Primary Care Teams (Family Health Teams and Primary Care Teams).	Population coverage estimated by EqAB.	Sum of population coverage/AB in the health macro-region/total population in the health macro-region x 100.	Population coverage estimated by EqAB by health macro-region.
Hospital care	Performance score of Hospitals evaluated in PNASS (2015-2016).	Hospital risk and quality component.	Average performance score of hospitals evaluated in the PNASS by municipality. From the average per municipality, the average for the health macro-region was calculated.	Average risk and quality component of PNASS hospitals by health macro-region
	Beds available for SUS hospitalization (except ambulatory care beds) and additional beds in October/2015.	Beds per thousand SUS inhabitants.	Total number of SUS Hospital beds in the macro-region / total population in the health macro-region x 1000.	Beds per thousand inhabitants/SUS by health macro-region.
	Hospital admission resolubility rate (year 2016)	Resolubility rate for medium complexity hospital admissions.	Number of hospitalizations of medium complexity (MCH1 and MCH2) carried out by residents of the health micro-region, in the micro-region of residence / Total of hospitalizations of medium complexity (MCH1 and MCH2) carried out by residents of the health micro-region x 100.	Average resolubility rate for medium-complexity hospital admissions by health macro-region

Variable	Average	Standard deviation	Minimum value	Maximum value
Primary care
1. AB quality component	52.36	5.85	37.38	66.30
2. Population coverage estimated by EqAB	79.99	14.46	43.81	100.00
Hospital care
3. Hospital risk and quality component/PNASS	63.38	14.47	26.78	94.89
4. Beds per thousand inhabitants - SUS	1.7	0.44	0.61	2.91
5. Resolubility Rate	77.61	11.46	45.02	98.05

Region/estate	Variables
	Primary care		Hospital care
	AB quality component	Population coverage estimated by EqAB	Hospital risk and quality component/ PNASS	Bed coverage per thousand inhabitants - SUS	Resolubility Rate
North
Acre	39,20	91,78	57,12	1,71	88,95
Amapá	40,78	90	26,78	1,38	64,91
Amazonas	39,37	67,52	42,29	1,39	85,17
Pará	46,98	61,94	51,98	1,43	83,13
Rondônia	41,43	76,67	67	2,01	71,09
Roraima	47,14	78,19	65,32	1,75	75,9
Tocantins	49,83	94,31	47,73	1,57	66,75
Average/region	43,53	80,05	51,2	1,6	76,55
North east
Alagoas	48,38	83,91	58,38	1,53	56,70
Bahia	51,58	80,48	62,34	1,57	80,23
Ceará	57,39	91,61	62,65	1,74	66,33
Pernambuco	50,93	83,98	56,13	1,81	64,34
Maranhão	44,10	91,89	39,86	1,78	73,54
Paraíba	48,97	97,90	46,39	1,94	52,39
Piauí	50,02	99,29*	43,07	1,95	73,47
Rio Grande do Norte	56,45	87,91	49,73	1,86	54,28
Sergipe	49,93	89,89	72,64	1,24	45,02
Average/region	50,27	88,74	54,68	1,72	70,32
Central-west
Goiás	50,74	72,14	54,36	1,72	66,06
Mato Grosso	49,85	72,02	45,41	1,72	83,03
Mato Grosso do Sul	49,12	73,06	76	1,54	95,25
Distrito Federal	48,72	61,94	60,91	1,55	97,27*
Average/region	50,17	70,97	56,8	1,67	75,73
Southeast
Espírito Santo	44,68	73,39	54,83	1,58	85,28
Minas Gerais	54,58	86,79	66,84	1,58	80,29
São Paulo	55,56	60,42	77,93*	1,44	82,06
Rio de Janeiro	44,97	60,33	61,56	1,61	91,67
Average/region	54,5	71,53	72,2	1,50	81,74
South
Paraná	54,03	80,40	76,61	1,92	80,08
Rio Grande do Sul	52,39	74,43	66,49	2,18*	85,65
Santa Catarina	61,11*	87,21	73,96	1,87	87,19
Average/region	56,64	81,37	71,9	1,98	85,22
Brazil average	52,36	79,99	63,38	1,7	77,61

Variable	Group 1	Group 2	Group 3
Primary care
AB Quality Component	48.09 (low)	51.98 (low)	56.60 (high)
Population coverage estimated by EqAB	81.83 (high)	78.14 (high)	78.50 (high)
Hospital care
Risk and quality component of evaluated hospitals/PNASS	54.14 (low)	59.05 (low)	73.16 (high)
Beds per thousand inhabitants - SUS	1.76 (average)	1.54 (low)	1.66 (average)
Resolubility rate	77.07 (high)	53.04 (average)	82.24 (high)
Characteristics
Number of macro-regions	47	8	48
% of total macro-regions	45.63	7.76	46.60
Number of municipalities	2678	406	2468
% of total municipalities	48.23	7.31	44.45
Population (2014 projection)	99,583,898	19,662,830	83,408,168
% of the total population	49.13	9.70	41.15

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] Chief editors:

Maria Cecília de Souza Minayo, Romeu Gomes, Antônio Augusto Moura da Silva