The Unified Health System and the challenge of regionalized and contractualized management

Abstract

Objective: To analyze the regional health planning, with emphasis on the use of different types of management modalities and their effects on the guarantee of the right to health. Methods: Qualitative, cartographic study based on Deleuzean concepts, addressing the experience of Ceará with use of two investigative layers, the state, from 2013 to June 2015, with interviews of 23 state health managers, ddressing their institutionalization; and in the Sobral Health Region, from February to September 2016, discussing the types of management adopted in public referral units, with interviews of 14 managers, 11 professionals and 12 users. The discourse analysis was based on the Foucauldian approach and authors on the field of collective health. Results: Regionalization has become a strategy for the health care reform in Ceará since 1990, and institutionalized different management modalities, by means of the Public Consortia of Health and Social Organization, operated by the contractual mechanism of health services. This has established a regionalized management, contractualized by results, coupling the legal and care dimensions, with real effects to the right to health, restricted to contracted and paid items, and outlining a pattern of service coverage. Final considerations: Coupling contractualization with regionalization proved to be potent in modeling the Unified Health System on the Universal Health Coverage ideology, by institutionalizing the shift from comprehensive and universal to partial and focal, and from the public to privatizing the management of its equipment; the commodification of health care as consumer goods rather than a social right, and the managerial approach to its means of production.