0223/2020 - A two-step planning method to increase accessibility to medium complexity procedures for public secondary healthcare Um método de planejamento em duas etapas para aumentar a acessibilidade a procedimentos de média complexidade para serviços de saúde pública em cuidados secundários
A atenção especializada do sistema público de saúde brasileiro é crítica e subfinanciada. Poucos estudos avaliaram o planejamento da atenção secundária em um nível estratégico, portanto ainda há questões em aberto a serem examinadas. Este estudo objetiva determinar a localização de centros médicos e a quantidade de equipamentos com base em um processo de otimização em duas etapas para atender a população. Balanceamos decisões conflitantes de propensão dos médicos em trabalharem em metrópoles e de pacientes em mudarem o mínimo de seus municípios para fornecer a localização dos centros médicos, e equipamentos a esses locais e as horas adicionais de especialistas para atender aos padrões oficiais de demanda. Para a demanda restante, a segunda etapa do modelo de otimização sugere a aquisição de equipamento para os centros médicos eleitos, para atender às necessidades. A localização proposta das unidades de atendimento secundário abrange 834 municípios, correspondendo a 97,77% do estado, com um deslocamento médio de pacientes de 58,73 km (IC 95%: 56,18 km - 61,28 km). Em geral, 39 das 77 regiões de saúde devem contratar horas adicionais de especialidades médicas. Pediatria e ginecologia representam a maior lacuna.
Palavras-chave:
Planejamento da saúde pública, cuidados secundários, localização de centros médicos.
Abstract:
The specialized care level of the public Brazilian national health system is critical and chronically underfunded. Few studies have evaluated public secondary care planning on a strategic level, so there are open issues yet to examine. This study aims at locating medical centers and sizing equipment based on a two-step optimization process to meet the population\'s needs. The models consider physicians\' propensity for working on a metropolis and the patients’ choice on moving the leasttheir municipalities, therefore, conflicting decisions. The models provide the location of medical centers, the assignment of equipment to such locations, and the additional hours of specialists required to meet official standards of demand. Available equipment with idle capacity should partly satisfy the requirement for exams within the current infrastructure. For the remaining uncovered demand, the second step of the optimization model suggests the acquisition of additional equipment for the elected medical centers to meet established needs. The proposed location of secondary care facilities covers 834 municipalities, corresponding to 97.77% of the estate, with an average patient displacement of 58.73 km (CI 95%: 56.18 km - 61.28 km). In general, 39 out of 77 health regions should hire additional hours of medical specialties. Pediatrics and gynecology represent the major gap.
Keywords:
Public health; care planning; secondary care; geographical location; optimization
Um método de planejamento em duas etapas para aumentar a acessibilidade a procedimentos de média complexidade para serviços de saúde pública em cuidados secundários
Resumo (abstract):
The specialized care level of the public Brazilian national health system is critical and chronically underfunded. Few studies have evaluated public secondary care planning on a strategic level, so there are open issues yet to examine. This study aims at locating medical centers and sizing equipment based on a two-step optimization process to meet the population\'s needs. The models consider physicians\' propensity for working on a metropolis and the patients’ choice on moving the leasttheir municipalities, therefore, conflicting decisions. The models provide the location of medical centers, the assignment of equipment to such locations, and the additional hours of specialists required to meet official standards of demand. Available equipment with idle capacity should partly satisfy the requirement for exams within the current infrastructure. For the remaining uncovered demand, the second step of the optimization model suggests the acquisition of additional equipment for the elected medical centers to meet established needs. The proposed location of secondary care facilities covers 834 municipalities, corresponding to 97.77% of the estate, with an average patient displacement of 58.73 km (CI 95%: 56.18 km - 61.28 km). In general, 39 out of 77 health regions should hire additional hours of medical specialties. Pediatrics and gynecology represent the major gap.
Palavras-chave (keywords):
Public health; care planning; secondary care; geographical location; optimization
Almeida, J.F.F, Campos, F.C.C. A two-step planning method to increase accessibility to medium complexity procedures for public secondary healthcare. Cien Saude Colet [periódico na internet] (2020/jul). [Citado em 22/12/2024].
Está disponível em: http://cienciaesaudecoletiva.com.br/artigos/a-twostep-planning-method-to-increase-accessibility-to-medium-complexity-procedures-for-public-secondary-healthcare/17705?id=17705
