0209/2018 - Integração de rede e coordenação do cuidado: o caso do sistema de saúde do Chile. Network integration and care coordination: the case of Chile\'s health system.
O artigo analisa a implementação de redes integradas de serviços de saúde (RISS) e das estratégias para coordenação do cuidado pela APS no sistema de saúde do Chile em seu segmento público. Foram realizadas entrevistas semiestruturadas com policymakers do sistema público de saúde e academia, complementado por análise documental e revisão bibliográfica. O país destaca-se pela institucionalização de instrumentos de coordenação do cuidado amplamente reconhecidos como mapas de derivação, médico gestor de demanda, prontuários eletrônicos e, sobretudo, definição de protocolos, sob forte liderança do Ministério da Saúde e condução pelos gestores dos Servicios de Salud, espaço regional de construção das RISS. Contudo, identificam-se camadas de segmentação e fragmentação ao interior do subsistema público com a manutenção da livre-eleição para consultas especializadas e duplas filas de espera – uma para os procedimentos com garantias explícitas de acesso e outra para os demais. A experiência chilena demonstra necessidade de maior protagonismo da APS para que seja capaz de assumir a condução das RISS. No país, as redes parecem orbitar ao redor de grandes e potentes hospitais. Elementos do contexto mais amplo do sistema de saúde também condicionam avanços e impasses no desenvolvimento das estratégias analisadas.
Palavras-chave:
Integração de Sistemas; atenção primária à saúde; Chile
Abstract:
The article analyzes the implementation of integrated healthcare networks (RISS) and the strategies for care coordination by PHC in the Chilean public health system. Semi-structured interviews were conducted with policymakersthe public health system and academics, complemented by documentary analysis and bibliographic review. The country stands out for the institutionalization of care coordination instruments widely recognized, such as referral maps, demand manager physician, electronic records and, mainly, definition of protocols, under the strong leadership of the Ministry of Health and conduction by the Servicios de Salud managers, regional space for the construction of RISS. However, segmentation and fragmentation’s degrees within the public subsystem were identified, with the maintenance of free-choice for specialized medical appointment and double waiting lists - one for procedures with explicit access guarantees and another for others cases. The Chilean experience demonstrates the need for a greater role for PHC so it will be able to take on the leadership of RISS. In the country, the network seems to orbit around large and powerful hospitals. Elements of a broader context of the health system also condition advances and impasses in the development of the analyzed strategies.
Network integration and care coordination: the case of Chile\'s health system.
Resumo (abstract):
The article analyzes the implementation of integrated healthcare networks (RISS) and the strategies for care coordination by PHC in the Chilean public health system. Semi-structured interviews were conducted with policymakersthe public health system and academics, complemented by documentary analysis and bibliographic review. The country stands out for the institutionalization of care coordination instruments widely recognized, such as referral maps, demand manager physician, electronic records and, mainly, definition of protocols, under the strong leadership of the Ministry of Health and conduction by the Servicios de Salud managers, regional space for the construction of RISS. However, segmentation and fragmentation’s degrees within the public subsystem were identified, with the maintenance of free-choice for specialized medical appointment and double waiting lists - one for procedures with explicit access guarantees and another for others cases. The Chilean experience demonstrates the need for a greater role for PHC so it will be able to take on the leadership of RISS. In the country, the network seems to orbit around large and powerful hospitals. Elements of a broader context of the health system also condition advances and impasses in the development of the analyzed strategies.
Almeida, Patty, Oliveira, SC, Giovanella, L.. Integração de rede e coordenação do cuidado: o caso do sistema de saúde do Chile.. Cien Saude Colet [periódico na internet] (2018/Abr). [Citado em 08/11/2024].
Está disponível em: http://cienciaesaudecoletiva.com.br/artigos/integracao-de-rede-e-coordenacao-do-cuidado-o-caso-do-sistema-de-saude-do-chile/16742?id=16742
