Regulation of access to hospital beds in emergency care and the development of integrated health services
Comprehensive health care delivery is a major challenge for the Brazilian Unified Health System. Inadequate coordination among different health care levels and facilities produces poor access to health care and low degree of integration across levels of care, that is worse in emergency care delivery. Health policy has focused on health care networks development and regulation of access to health care provision. In the city of Rio de Janeiro, local health policy has prioritized the development
... an Emergency Care Network. This research aimed at assessing the access to hospital beds and diagnostic resources, fundamental to continuity of care this network. Methods: Triangulation technique was employed, collecting of data from different sources and analysis resorting to multiple methods. Analysis of data from primary and secondary databases was performed. Interviews were conducted with managers and healthcare professionals involved in guaranteeing continuity of care in Emergency Care Network. Data analysis resorted to descriptive statistics and the interviews along with the data were interpreted under the conceptual framework of Integrated Health Care. Results: Poor access to hospital beds constituted a major obstacle to improvements in continuity of care for patients in Emergency Care Network. An insufficient number of hospital beds is the primary issue. Other aspects of hospital care contribute to aggravate this deficiency: the predominance of general hospitals, the existence of small and underequipped hospitals, prolonged lengths of stay and significant discrepancies of bed occupancy rates among specialized and general hospitals. Hospitals further face disrupted internal workflows due to inadequacy and limited availability of human and physical resources. Moreover, weak cooperation between federal, state and local government leads to persistence of a fragmented network with little or absent interaction among health care facilities and professionals from different government spheres. Conclusion: To reach a better degree of Methods This research aimed at assessing how the access to hospital beds and diagnostic and therapeutic resources, fundamental to provide continuity of assistance in the Emergency Care Network, affects the development of integrated health care networks. This study was conducted within the Emergency Care Network of the city of Rio de Janeiro, Rio de Janeiro, Brazil. This network is composed of health care facilities managed by all three federative levels: municipal level, state level and federal level. The city was selected owing to its relevance in the national scenario, as the second largest in Brazil, to the authors engagement in the local health system and to the recent and robust expansion of the Emergency Care Network, carried out by policies that focused on emergency care 4,5 .