Dos princípios que fundamentam o Sistema Único de Saúde à sua operacionalização: um estudo de algumas experiências locais na aplicação do piso de atenção básica.

Abstract

This work aims to investigate some aspects related to the creation of the Sistema Unico de Saude (SUS) in Brazil, focusing in the gap between the original proposal and the current implementation of this system. It reviews the work of authors who research and register the path of this system from the historical perspective of different social segments of the society who fight for the adoption of a health police for this country, in particular the Sanitary Movement. The review includes institutional documents and specific legislation, such as government edicts and Basic Operational Rules. Following the conceptual discussion and historical context presentation, which make the first two sections of this dissertation, the third section aims to characterise what can be considered the predominant trends in the building of the local health systems. In this sense, a comparative analysis was made between two groups of towns. The analysis compares towns that adopted, in a pioneer basis, the partial administration model and towns that did not adopt this model, since it was expected that the former group would be more advanced in the decentralisation process than the later. The results of this comparative analysis, based upon the set of chosen variables, revealed that there are no significant differences between the two groups of towns. On the other hand, it was noticed that in the more recent years of the studied period, there has been an indistinct trend in the two groups for a growing basic sanitary attention, that matches the period of creation of the Basic Assistance Plan - PAB of municipal assisted health care. As far as hospital attention is concerned, it was observed a growing prevalence of the public health assistance in relation to its private counterpart. This work suggests that similar analysis should be made over a larger period of time and should consider a broader set of variables, in order to continue this study on the installation of the PAB in Brazil.