Distribuição espacial das internações hospitalares realizadas pelo Sistema Único de Saúde (SUS) em Minas Gerais, 2002: deslocamentos populacionais e tipos de procedimentos

Abstract

In Brazil, the Unified Health System (SUS) has experienced several changes since the 1980s, that aimed at decentralizing and regionalizing the system. This study analyzes the utilization of the health services of the SUS and the accessibility to them in this context of regionalization through the description and mapping of patients flows and the average distance they traveled to obtain hospitalization, in Minas Gerais state, in 2002. The measure considered to study the health services utilization was medical procedures that were classified into high and medium complexity, strategics and psychiatrics. The database utilized was Authorizations of Hospitalization (AIHs) and the regionalization adopted was that proposed by Minas Gerais Director Plan for Regionalization 2003/2006 (PDR MG 2003/2006), that subdivides the state into macro and micro regions. Such regionalization has the aim at promoting better health services allocation, creating a more equitable and efficient system. But these concepts are in conflict with each other, since, at times, it is necessary to concentrate some services in a specific locality to take advantage of the economies of scale. The results point to the necessity of reviewing the PDR MG 2003/2006 regionalization, due to the fact that in some health macro regions the residents have to travel long distances to be assisted, especially in the case of high complexity procedures, which are concentrated only in a few number of cities. For instance, in 2002, no hospitalization demanding high complexity procedures was recorded for the macrorregion of Jequitinhonha, the less developed region of Minas Gerais, and 95 percent of the patients were attended in the macrorregion Centro, especially in the city of Belo Horizonte (the capital of the state of Minas Gerais). On the other hand, the medium complexity assistance is better distributed in Minas Gerais and for those procedures, patients have to travel shorter distances to be assisted. Although this study does not present data of the transportation road system quality, it is known that in Minas Gerais the quality of such system is worse in those areas from which the largest number of patients forwarded come from, adding to the problem of the distance itself. Therefore it is important that the discussion about the regionalization process also incorporates the analysis of other socio-economic factors, in a way that it does not implicate in consolidating or stressing the regional differentials that are actually supposed to be diminished.