The users access to the public health system in the borough of Ijuí/RS: a controversial scenery. / O acesso na rede pública de saúde no município de Ijuí/RS: um cenário de controvérsias

AUTOR(ES)
DATA DE PUBLICAÇÃO

2008

RESUMO

The purpose of this study is to understand the organization of the regulation of the users access to the public health system in a borough from the countryside of the state of RS, describe the organization of the health system and analyze the access of the users in the Basic Attention and Average Complexity sectors. The theoretical framework of the access and health attention regulation was chosen to subsidy the system access analysis in the health attention system in Ijuí/RS. The empirical basis was built from recorded interviews with managers, service employees and a representative of the users, totaling 10 interviews, as well as from the carrying out of a focal with users of the public health system. Along with the interviews and the focal group, a study about the profile of the users of the public health system, who used the services of the local Emergency Room, was done and complemented by observations carried out in the Conventional Health Unit (UCS), Family Health Team and Emergency Room (OS) at Ijuis Charity Hospital (HCI). From a qualitative approach, supported by the thematic analysis, the empirical material was interpreted and discussed. Four empirical categories were identified: a) the existence of a system in the place; b) the access to Basic Attention the several entrance doors; c) the organization of the access to Average Complexity; and d) conflicting relationships in the attention system. The analysis enabled us to understand the organization of the access of the users of the public health system of Ijuí/RS to the services of Basic Attention and Average Complexity. We noticed the frailties and difficulties to receive the services in the Basic Attention sector, since in the majority of the UCS and ESF, the access criterion is defined by a pre-established number of attendance cards. It was observed that the majority of the users search for the basic units to obtain medical consultation, strangling the access in the several entrance doors while harnessing the organization of the processes of work of the other professionals to the doctor, limiting the potential present in these spaces. Regarding the users access to the hospital and out-patient clinics of Average Complexity, it was found in the local scenery the mediation of a hired employee who assumes the intermediation of the this level of organization of the health system. Frailties were identified in the tools and mechanisms of regulation of the users access, a fact that contributes to the optimization of a local practice called social fee, which represents the co-payment by the user of the public health system in order to obtain the services needed in a more agile and differentiated way. The scenery reveals different interests, something that generates conflicts among the managers, employees and users, revealing the fragility of the public health system in Ijuí/RS. The study points out the possibility of organizing the users access to the public health system if there was a system with the capacity of addressing the needs of all users.

ASSUNTO(S)

health services access acesso a serviços de saúde atenção básica basic attention health system sistema de saúde

ACESSO AO ARTIGO

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