Sancho Leyla Gomes, Geremia Daniela Savi, Dain Sulamis, Geremia Fabiano, Leão Cláudio José Silva
Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro (UFRJ). Av. Horácio Macedo S/N, Ilha do Fundão. 21941-598 Rio de Janeiro RJ Brasil.
Curso de Graduação em Enfermagem, Universidade Federal da Fronteira Sul. Chapecó SC Brasil.
Cien Saude Colet. 2017 Apr;22(4):1121-1130. doi: 10.1590/1413-81232017224.2694016.
This study analyzes the incidence of transaction costs in the regionalization process of health policies in the Brazilian federal system. In this work, regionalized health actions contracted and agreed between federal agencies have assumed a transactional nature. A conceptual theoretical essay of reflective nature was prepared with the purpose of questioning and proposing new approaches to improve the health regionalization process. The main considerations suggest that institutional management tools proposed by the standards and regulations of the Unified Health System have a low potential to reduce transaction costs, especially due to hardships in reconciling common goals among the entities, environment surrounded by uncertainty, asymmetries and incomplete information, bounded rationality and conflict of interest. However, regionalization can reduce the incidence of social and/or operational costs, through improved access to health and the construction of more efficient governance models.
本研究分析了巴西联邦体系中卫生政策区域化进程中交易成本的发生率。在这项工作中，联邦机构之间签订并商定的区域化卫生行动具有交易性质。撰写了一篇具有反思性质的概念性理论文章，旨在质疑并提出改进卫生区域化进程的新方法。主要考虑因素表明，统一卫生系统的标准和法规所提出的机构管理工具降低交易成本的潜力较低，特别是由于各实体之间协调共同目标存在困难、处于不确定性、不对称和信息不完整的环境中、有限理性以及利益冲突。然而，区域化可以通过改善卫生服务可及性和构建更高效的治理模式来降低社会和/或运营成本的发生率。
