New perspectives for the regionalization of health care in Brazil

Regionalization is presented as one of the assumptions of the current phase of the decentralization of the Unified Health System (SUS) and a process of utmost importance to reduce the major inequalities of Brazil. This study analyzes that process in the state of São Paulo. In this context, the São Paulo State Plan for Health Care sets forth the reformulation of the regional health structure according to the Health Pact (Ministry of Health, 2006). The Plan foresees the organization of new health care regions via agreement between towns, and their Regional Management Committees. The State Health Secretary therefore reconsiders its role in the regionalization of the system. Despite significant progress, a renewed prospect for the regionalization of health is needed so that a more effective national project in line with the regional diversities of the country can be established in Brazil.  The study aims to identify the conditioning factors for the regional restructuring of health care in São Paulo state and to contribute to supporting the construction of a wider and politically reinforced regional structure, considering: the private health care sector; intercity consortiums; intercity inequalities; and the internal organization of the SES. This study presents a discussion about the regional category and process of regionalization within the dynamics of the Brazilian territory, based on an all-encompassing vision of the public and private health care services of the region.    The principal results include: the identification of groups with different rationales of regional health care activities; the analysis of the relationship between these groups and the different economic dynamics of the territory; the identification of overlap points between the different rationales; and, finally, the proposition that the public system should break off from a vision of regionalizing health care without understanding the part played by the private sector in the different locations.