Access to Specialized Care in the SUS: challenges for the implementation of care-producing regulatory devices

Abstract

This study sought to identify and analyze the regulatory devices used in the Brazilian Unified Health System (SUS, in the Portuguese acronym) to promote attention in care networks and equitable and timely access to specialized outpatient care (AAE, in the Portuguese acronym). This is a qualitative, multiple case study developed through interviews and focus groups with managers, workers, and users of the SUS, carried out in two municipalities of different sizes in the Metropolitan Region of São Paulo. The conclusions are discussed from three levels of visibility: the complementarity of the Regulatory Center’s access regulation actions with the services; the challenge of reconciling spontaneous and programmatic demand in Primary Health Care (APS, in the acronym in Portuguese); and the need for a less prescriptive and more caring AAE. The results point to the importance of regulatory processes carried out based on services, which approach the needs of users and act in conjunction with regulatory centers. In this sense, reception with qualified listening in APS, which contributes to the knowledge of the people and the production of shared care with AAE, becomes an important regulatory strategy, combined with the use of light and relational technologies, which brings professionals closer to services and enables the organization of care lines.