Oferta de serviço assistencial hospitalar em município de pequeno porte: estudo de caso do município de Mendes – RJ

Abstract

The main objective of this dissertation is to look into the provision of hospital care services in a small municipality in the state of Rio de Janeiro in 2019, considering the national strategy for small hospitals and the health care regionalization guideline. Some issues become apparent: i) the decentralization of care responsibilities to states, particularly municipalities, as a SUS guideline; ii) the inconsistency between decentralization of responsibilities and insufficient decentralization of resources; iii) difficulties in regionalizing the provision of services (particularly specialized ones, such as hospitals); iv) the complexity of guaranteeing hospital supply in low-scale contexts - small hospitals; v) shared service finance using municipal resources as well as resources transferred from the state and federal governments. The methodological approach is exploratory research with a qualitative approach, employing the case study technique, with data collected through administrative processes, documents published in the “Diario Oficial”, Ministry of Health information systems (SIH, SIA, SISMAC, SIOPS, FNS), and direct observation in the hospital unit. The literature study includes a presentation of the significant papers linked to the topic from a cutting-edge perspective, as well as hospital care legislation. In addition to the characterization of the hospital unit in Mendes/RJ, comparative data on hospital treatment in the Center-South region will be presented in the analysis and discussion. Furthermore, it appears that the National Policy for Small Hospitals did not ensure their organization and sustainability, and that the State of Rio de Janeiro lacks a well-defined policy for such hospital units. Municipalities are responsible for this policy. Many questions developed while study that might stimulate further research and follow-up on cases like the one highlighted. Among them: is it possible, even under the current political model, for a small town to reconfigure its hospital network by including it into the regional RAS? Would regionalization give such an action "force"? With the current finance mechanisms in place, does the utilization of these structures to fill the region's care shortages provide sufficient financing for its sustainability? Some issues have been settled, while others happened during the study, leading us to the conclusion that we urgently need to take stock of what we have implemented in our municipalities and what type of Public Health System we are building with our current actions.