干旱区生态环境知识资源中心(Arid): Provision of specialized care in remote rural municipalities of the Brazilian semi-arid region

Arid

DOI	10.22605/RRH6652
	Provision of specialized care in remote rural municipalities of the Brazilian semi-arid region
	de Almeida, Patty Fidelis; dos Santos, Adriano Maia; da Silva Cabral, Lucas Manoel; Bousquat, Aylene; Fausto, Marcia Cristina
通讯作者	de Almeida, PF (corresponding author)，Fed Fluminense Univ, Collect Hlth Inst, Niteroi, RJ, Brazil.
来源期刊	RURAL AND REMOTE HEALTH
ISSN	1445-6354
出版年	2021
卷号	21 期号:4
英文摘要	Introduction: Specialized care barriers are widespread and multifactorial, with consequences for timely access, health outcomes, and equity, especially in rural contexts. This article aims to identify and analyze arrangements for providing specialized care in the Brazilian remote rural municipalities (RRMs). Methods: This is a multiple-case qualitative case study developed in seven RRMs located in the Brazilian semi-arid region. Twenty-two semi-structured interviews were conducted with the public health system managers, complemented by analysis of secondary data from national health information systems. Thematic content analysis was guided by the Integrated Health Service Network attributes related to the provision of specialized care. Results: Socioeconomic indicators and indicators of availability and accessibility to health services express the context of greater vulnerability of RRM and their respective health regions when compared to states and the country. The analyzed cases do not come close to the RISS constitutive attributes. Various arrangements for the provision and financing of specialized care in the RRM were identified: public provision through an agreement between managers in the health region, health consortia, public provision in the municipality itself or neighboring municipalities, provision in private health services through direct purchase (out-of-pocket), and telehealth (very incipient). Such arrangements were unable to respond quantitatively and qualitatively to the demand for specialized care. Providing timely specialized care in an adequate place is not achieved, resulting in a fragmented, low-resolution model. The fragility of regionalized networks, aggravated by underfunding of the Brazilian Unified Health System, insufficient logistical support, and computerization of health services, contributes to care gaps and unacceptably long travel times for common specialized procedures, with more severe effects for people residing in the rural areas of the municipalities. Conclusion: Brazil's disorganization or lack of a systemic response based on regionalized health networks generates several care improvisations. The less structured the RISS, the more informal arrangements are made, with gains for the private sector to the detriment of public health system users.
英文关键词	access to health services Brazil integration of health services rural health services secondary care
类型	Article
语种	英语
开放获取类型	gold
收录类别	SCI-E ; SSCI
WOS记录号	WOS:000751862000010
WOS关键词	HEALTH ; SERVICES ; BARRIERS ; ACCESS
WOS类目	Public, Environmental & Occupational Health
WOS研究方向	Public, Environmental & Occupational Health
资源类型	期刊论文
条目标识符	http://119.78.100.177/qdio/handle/2XILL650/375991
作者单位	[de Almeida, Patty Fidelis] Fed Fluminense Univ, Collect Hlth Inst, Niteroi, RJ, Brazil; [dos Santos, Adriano Maia] Univ Fed Bahia, Multidisciplinary Hlth Inst, Vitoria Da Conquista, BA, Brazil; [da Silva Cabral, Lucas Manoel] Univ Estado Rio De Janeiro, Inst Social Med, Rio De Janeiro, RJ, Brazil; [Bousquat, Aylene] Univ Sao Paulo, Publ Hlth Fac, Sao Paulo, SP, Brazil; [Fausto, Marcia Cristina] Fundacao Oswaldo Cruz, Natl Sch Publ Hlth Sergio Arouca, Rio De Janeiro, RJ, Brazil
推荐引用方式 GB/T 7714	de Almeida, Patty Fidelis,dos Santos, Adriano Maia,da Silva Cabral, Lucas Manoel,et al. Provision of specialized care in remote rural municipalities of the Brazilian semi-arid region[J],2021,21(4).
APA	de Almeida, Patty Fidelis,dos Santos, Adriano Maia,da Silva Cabral, Lucas Manoel,Bousquat, Aylene,&Fausto, Marcia Cristina.(2021).Provision of specialized care in remote rural municipalities of the Brazilian semi-arid region.RURAL AND REMOTE HEALTH,21(4).
MLA	de Almeida, Patty Fidelis,et al."Provision of specialized care in remote rural municipalities of the Brazilian semi-arid region".RURAL AND REMOTE HEALTH 21.4(2021).