From Territorial Regionalization to Thematic Networks: what are the repercussions for health responsibility and the regionalization model of care in the SUS?

Abstract

The objective of this study was to analyze the regionalization process in the Brazilian health system from a normative point of view. This is a documentary study that brought together five legal and ten infra-legal regulations that structure the SUS from 1988 to 2023. As complementary documents, the National Policies for Primary Care (PNAB), Specialized Care (PNAE) and Hospital Care (PNHOSP) were analyzed. The following information was extracted: year, regulation, type of regulation, network concept, territorial design and territorial organization, and it was possible to identify three phases in the regionalization process: The first phase is marked by the concept of regionalization as a constitutional and organizational precept of the SUS; the second phase is a transitional phase, with no mirroring between the legal and sub-legal regulations of the SUS and changes in the concept of territorial regionalization for thematic networks; the third phase is the consolidation of the sub-legal regulations of the SUS and the instrumentalization of Regionalization, where Integrated Regional Planning (IRP) becomes a planning method. As a result, there is a legal and conceptual void in the SUS due to the fragmentation of the territory into thematic networks; the lack of understanding of the health responsibility of hospitals; the separation between regional design and health planning; and the significant increase in the number of planning instruments in the SUS. It is concluded that there is no mirroring between the legal and sub-legal regulations in the concept of regionalization and a new legal framework is recommended in the SUS, in which the territorial areas and thematic networks are reorganized in light of the constitutional concept and the territorial precepts of the Dawson Report.