Decentralization of health system: analysis of regional inequality in Minas Gerais
Since 1988, health public policies in Brazil guided by the Federal Constitution, which was promulgated in that year, are based on the principles of universality and fairness regarding the access to action and services, as well as lines of direction of management decentralization, completeness of assistance and community participation in the organization of the Unified Health System in the domestic territory. Such process of reform demanded theoretical formularizations and initiatives of governmental agencies and civil society for its implementation. These challenges are already institutionalized in the set of principles and lines of direction of the Unified Health System (SUS) that, since its regulation in 1990, has gone through a series of transformations, such as decentralization, regionalization and hierarchization of health services, in order to reduce the geographic and social inequalities in the access to these services. The aim of this research was to evaluate whether with the changes, the decentralization of public health policies, which would have to improve the management of health services in Brazil and to organize the system properly, had really reduced the inequality in this sector. The methodology that gave support to the objectives of this work was based on factorial and cluster analyses and the construction of Health Indexes. Aiming at identifying the factors representing basic health services and municipal infrastructure, factorial analysis was applied, grouping the variables with high correlation degree, obtaining four factors: Sanitary infrastructure (F1), Vaccine Covering (F2), Hospital Assistance (F3) and Investment in Health (F4), which reflect the health situation in the various cities from 2000 to 2004. To identify homogeneous groups, the cluster analysis was carried out in order to group the cities according to the performance. Finally, using the factorials to construct the Health Indexes, which made it possible to hierarchize and identify inequalities in the access to public health services, as well as to characterize and group the cities regarding the health conditions, bringing better understanding to intermunicipal disparities. The main contributions of this work were to group the cities according to performance factors that represented the 14 variables considered in this work, showing marked contrasts in relation to the access of the population to basic health assistance and in the cities? infrastructure. Generally, the cities with higher economic capacity showed better performance, according to the calculated Health Index, suggesting that the decentralization process has not contributed to minimize the regional disparities in the access to public health services in the State, where there is still strong inter and intra-regional contrasts.
Advisor:Adriano Provezano Gomes; Marco Aurélio Marques Ferreira; Marcelo José Braga; Rosângela Minardi Mitre Cotta; Rosa Maria Olivera Fontes
School:Universidade Federal de Viçosa
Source Type:Master's Thesis
Keywords:Unified Health System (Brazil) Inequality Public policies Descentralization administration
Date of Publication:03/05/2007