Lay agency and the generation of public-private mix health care maps

Meneses, Consuelo Sampaio; Cecilio, Luiz Carlos de Oliveira; Andreazza, Rosemarie; Carapinheiro, Graça; Andrade, Maria da Graça Garcia; Santiago, Sílvia Maria; Araújo, Eliane Cardoso; Souza, Ana Lúcia Medeiros; Reis, Denizi Oliveira; Pinto, Nicanor Rodrigues da Silva; Spedo, Sandra Maria

doi:10.1590/1413-81232017226.14822016

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

FREE THEMES • Ciênc. saúde colet. 22 (6) • June 2017 • https://doi.org/10.1590/1413-81232017226.14822016 copy

Lay agency and the generation of public-private mix health care maps

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This paper discusses part of the results obtained from a study carried out in two cities of the so-called ABCD Paulista Region in the period 2010-2012, in an attempt to spot the existence of non-state regulatory rationale towards access and consumption of health care services. The first stage includes interviews carried out with strategic stakeholders (managers and politicians) and key workers players. The second stage collected the stories of 18 very frequent users of health care services. This study revealed the leading role played by users to produce “health care maps”, with emphasis on the frequent use of public and private resources in their itineraries, circumventing or merging with government regulation to obtain the care they need. The different formats of public-private mix transcend the still prevailing “official” concepts about the clear distinction between the two systems, which reveals the importance of this theme to public health management.

Health policy; Health care delivery; Health administration; Unified Health System; Prepaid health plans

Municipality	Title – Profession – Work Place	Work experience (years)
A	Mayor – architect	2
	Health Secretary – doctor	2
	Health Counselor – pharmacist	2
B	Mayor – metalworker	2
	Health Secretary – doctor	2
	Health Counselor – housewife	2
A	Doctor – UBS	23
	Nurse – SAMU	19
	Community Health Worker – UBS	10
B	Doctor – UBS and PA	22
	Nurse – UBS	16
	Community Health Worker – UBS	09

Respondent	Gender	Age (years)	Family status	Work status	Main health problems
Érica	Female	44	Married, 3 sons	Retired, she was a Community Health Worker (CHW)	Postpartum depression and panic syndrome
Tulipa	Female	47	Married, 1 son and a granddaughter. The son is a nurse.	Housewife – she owned a restaurant.	Diabetes Mellitus (DM), heart disease and gynecological hemorrhage - anemia.
Lírio e Acácia	Male	64	Married, 3 daughters, of which one is already deceased.	Retired. He was an automobile worker.	Systemic Arterial Hypertension (SAH), MD and heart disease
Miosótis	Female	35	Married, 3 sons. They all live together.	Housewife. She worked with transport.	Hypoglycemia and headache.
Hortência	Female	72	Separated, 3 sons. One of the daughters is a CHW in a UBS.	Retired. She was a housekeeper.	Arthrosis, asthma, hernia, SAH, DM and hearing difficulty
Orquídea	Female	39	Married, 7 sons. They all live together.	Housewife. She sold candies at traffic lights.	Special son: neurological and motor sequelae due to meningitis.
Manacá	Male	57	Married. 4 sons, 2 grandsons.	Retired. He was an automobile worker.	Accident at work, herniated disc, alcoholism, SAH
Jasmim	Male	47	Married, 1 daughter.	Retired. He was an automobile worker.	Accident at work - injury to the spine and severe hand injury.
Rosa	Female	48	Lives with the second husband and son of the first marriage.	Self-employed, she sells cleaning products. She was a food-manufacturing worker.	Breast cancer.
Margarida	Female	52	Married, 4 sons, 8 grandsons.	Day-worker. She has been unemployed for three years.	Rheumatoid arthritis, SAH and DM
Magnólia	Female	57	Married	Housewife.	Morbid obesity with gait problems
Flor de Bambu	Male	73	Married, 6 sons.	Retired. He was a metalworker.	SAH, chronic obstructive pulmonary disease (COPD), and heart disease
Cravo	Male	54	Married, 2 sons, lives with spouse and one son.	Retired. He was a metalworker.	SAH, Congestive Heart Failure (CHF) and cataract
Amarílis	Female	70	Widow, one daughter and 3 grandsons. Lives alone in a home adjacent to that of her sister.	Retired, she was a housekeeper and artisan (she sold at home).	SAH, DM and heart disease
Violeta	Female	70	Single, 2 children. Lives with the son, the daughter, the son-in-law and two grandsons.	Retired, general cleaning services worker at the local SUS services.	Currently, breast cancer
Camélia	Female	52	Widow, one son. Lives with the mother and the son.	Retired, she was a tailor and baby-sitter.	SAH, nephropathy and kidney transplantation
Jacinto	Male	60	Married, lives with spouse and a granddaughter they raise.	Retired for invalidity, he was security guard for a metalworking factory.	Has been a paraplegic for 17 years (he was shot at work while working as security guard)
Dália	Female	57	Lives with husband, a retired metalworker.	Housewife, but works as a tailor outside.	Osteoarthritis, ovarian cancer, benign thyroid nodule and SAH

ABRASCO - Associação Brasileira de Saúde Coletiva Av. Brasil, 4036 - sala 700 Manguinhos, 21040-361 Rio de Janeiro RJ - Brazil, Tel.: +55 21 3882-9153 / 3882-9151 - Rio de Janeiro - RJ - Brazil
E-mail: cienciasaudecoletiva@fiocruz.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Collaborations

CS Meneses is responsible for the design of the paper and worked on the collection and analysis of the empirical material, the writing of the paper and the approval of the final version. LCO Cecilio worked on the design and coordination of research, methodology, empirical material analysis, critical review of the paper and approved the final version. R Andreazza worked on the design and co-coordination of research, collection and analysis of empirical material, critical review and approval of the final version. G Carapinheiro worked on the design and co-coordination of the research, the critical review and the approval of the final version. MGG Andrade and SM Santiago worked on the collection and analysis of the empirical material, the writing of the paper and the approval of the final version. EC Araújo, ALM Souza, DO Reis, NRS Pinto and SM Spedo worked on the collection and analysis of empirical material, critical review and approval of the final version.

1. Flor de Bambu (A)	SUS + covenant	(73 years)
2. Jacinto (A)	SUS + covenant	(59 years)
3. Manacá (B)	SUS + covenant	(57 years)
4. Rosa (B)	SUS + covenant	(48 years)
5. Camélia (A)	SUS – had covenant	(52 years)
6. Cravo (A)	SUS – had covenant	(54 years)
7. Dália (A)	SUS – had covenant	(57 years)
8. Érica (B)	SUS – had covenant	(44 years)
9. Jasmim (B)	SUS – had covenant	(47 years)
10. Lírio (B)	SUS – had covenant	(64 years)
11. Magnólia (A)	SUS – had covenant	(57 years)
12. Margarida (A)	SUS – had covenant	(52 years)
13. Tulipa (B)	SUS – had covenant	(47 years)
14. Amarílis (A)	SUS + occasional out-of-pocket expenses	(70 years)
15. Orquídea (B)	SUS + occasional out-of-pocket expenses	(39 years
16. Hortênsia (B)	SUS exclusively	(72 years)
17. Miosótis (B)	SUS exclusively	(35 years)
18. Violeta (B)	SUS exclusively	(71 years)