Evaluation of the implementation of the National Health Regulation Policy

Abstract

The National Health Regulation Policy (PNRS) is a policy currently being implemented and under review to ensure better responses from the Brazilian public health system. Brazilian Federalism presupposes that the decentralization process of the Unified Health System (SUS) has a municipal basis but also involves a strong regional organization process. This means that the municipalization of health needs to go hand in hand with the regionalization of health. In this sense, regional governance occurs through the organization of health regions and macro-regions, which ensure comprehensive care and are agreed upon and monitored by the Regional Interagency Commissions (CIR), comprising municipalities and state management representation.The National Health Regulation Policy (PNRS) recognizes that to ensure full access to health regions, starting from primary health care (PHC), it is necessary to utilize instruments to regulate the system, care, and health actions and services. Health regulation has been recognized worldwide as an essential mechanism for managing health systems, mediating the private sector's performance to ensure social welfare in public health systems.Therefore, understanding the capillarity of the policy at the local level and its challenges for effective implementation will provide fundamental elements to improve access and quality to health actions and services. This includes ensuring timely and adequate waiting times, even considering the permanent difficulty of balancing supply and demand. Consequently, analyzing the process of regionalization, programming, and agreement of the SUS, as well as examining the relations with the market and the economic industrial complex of health, and the performance of care regulation on the mechanisms of supply and demand that influence the production and implementation of the policy, is justified. The aim is to achieve the production of networked, regional, comprehensive, timely, and transparent care.Furthermore, it is crucial to consider that waiting for access to specialized and hospital care in the SUS can have devastating effects on people's lives, particularly in diseases where timely care significantly impacts the condition's evolution and outcome, such as various types of cancer (CECILIO, 2014). Processes of network articulation, teleregulation, matrix support, and regional support have proven to be fundamental for improving access and quality in the SUS. Identifying the innovative technological arrangements of care regulation currently under development in the country is also essential to support the implementation of the policy. During the pandemic, the regulation of access to specialized and highly complex care has worsened, and strategies have been developed to minimize the problem, although with the risk of increasing the fragmentation of care. Managing and ensuring transparency of queues is a fundamental action of health care regulation, requiring macro and micro regulation mechanisms to ensure its effectiveness. The Department of Care Regulation and Control (DRAC) of the Specialized Care Secretariat of the Ministry of Health operates to develop and systematize actions for care regulation, programming of health actions and services, management and control of information systems, and evaluation of health services. Additionally, it manages allocating resources for medium and high-complexity services and the funding of regulation centers. (AU)