d'Avila Viana Ana Luiza, de Lima Luciana Dias, Ferreira Maria Paula
Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, 01246-903.
Cien Saude Colet. 2010 Aug;15(5):2317-26. doi: 10.1590/s1413-81232010000500007.
An explanation is required for the delay in implementing the regionalization strategy and the fragile nature of the combined decentralization and regionalization initiatives in Brazil. The article raises some hypotheses to clarify this intricate issue and reviews the structural conditioning factors of the regionalization process ongoing in the states. A national typology of the health care regions is prepared, differentiating them according to the degree of socio-economic development and the characteristics of the health care network and of the municipalities that form the Regional Management Boards (CGR), formally implanted by January 2010. Factorial and cluster analysis models were used to build the typology. Five major socio-economic groups of CGRs were identified, described according to their regional distribution, population, health care spending, profile of services offered (including the public-private sector mix) and health service coverage. The results obtained serve as guidelines for the constitution of health care networks and new initiatives at the regional level, in order to improve the regionalization policy and favour the construction of diverse and flexible regulatory instruments that are more in tune with the regional state of affairs.
需要对巴西区域化战略实施的延迟以及分权与区域化联合举措的脆弱性作出解释。本文提出了一些假设以阐明这一复杂问题，并审视了各州正在进行的区域化进程的结构制约因素。编制了一份全国医疗保健区域类型划分，根据社会经济发展程度、医疗保健网络特征以及构成区域管理委员会（CGR）的各市镇的特征对这些区域进行区分，区域管理委员会于2010年1月正式设立。运用因子分析和聚类分析模型来构建该类型划分。确定了CGR的五个主要社会经济群体，并根据其区域分布、人口、医疗保健支出、所提供服务的概况（包括公私部门混合情况）以及卫生服务覆盖范围进行描述。所获结果为区域一级医疗保健网络的构建和新举措提供了指导方针，以便改进区域化政策，并有利于构建更加符合区域实际情况的多样化且灵活的监管手段。
