O processo de consolidação da Política Nacional de Saúde Bucal: a atenção terciária como desafio da segunda década da política de saúde bucal do SUS

Abstract

This thesis aims to describe and analyze the development process of the National Oral Health Policy (PNSB) in the third level of assistance. To understand it, three research processes were performed. The first sought to map the spatial distribution of Brazilian hospitals with available beds in the public sector and check how many were registered for oral health assistance in the National Health Services Registry System (SCNES). The second used statistics tabulation tools (TABNET and TABWIN) from the Ministry of Health s data department (DATASUS) to search for the registration of Hospital Admission Authorization (AIH) with procedure code 041402041-3 (Dental treatment for patients with special needs) in the country in the biennium 2011/12. Fifteen analysis categories were considered. The third examined the Ministry of Health s website for the existing Regional Management Commissions (CIR) in Brazil until December 2012 as well as for the Master Regionalization Plans (PDR) and the State Health Plans (PES) of the 26 Brazilian states and the Federal District. These results were compared to the ones produced by the TABWIN tool regarding hospital and residence venues of the users who have undergone the searched procedure in the Brazilian National Health System (the so-called SUS). In order to allow a comparative analysis of this process in an international perspective, three countries in North America and 31 European countries were surveyed on the oral health care procedures available in their public hospitals. The results revealed the current focalizing character of the PNSB in contrast to the hospital oral health care practiced in most studied countries. Among other results, the research showed that: Only 32% of the hospitals with AIH for the studied procedure have its oral care service registered in the SCNES; 1% of AIH is related to patients hospitalized for medical reasons; and 44% of the Brazilian states provide oral health care in hospitals in their management documents. Thus, some suggestions are presented for both PNSB normalization improvement, regarding the management of the health services network for the care of people with disabilities, and for the expansion and extension of oral health care for all inpatients or outpatients in SUS hospitals.