Lay agency and the generation of public-private mix health care maps

Consuelo Sampaio Meneses Luiz Carlos de Oliveira Cecilio Rosemarie Andreazza Graça Carapinheiro Maria da Graça Garcia Andrade Sílvia Maria Santiago Eliane Cardoso Araújo Ana Lúcia Medeiros Souza Denizi Oliveira Reis Nicanor Rodrigues da Silva Pinto Sandra Maria Spedo About the authors


This paper discusses part of the results obtained from a study carried out in two cities of the so-called ABCD Paulista Region in the period 2010-2012, in an attempt to spot the existence of non-state regulatory rationale towards access and consumption of health care services. The first stage includes interviews carried out with strategic stakeholders (managers and politicians) and key workers players. The second stage collected the stories of 18 very frequent users of health care services. This study revealed the leading role played by users to produce “health care maps”, with emphasis on the frequent use of public and private resources in their itineraries, circumventing or merging with government regulation to obtain the care they need. The different formats of public-private mix transcend the still prevailing “official” concepts about the clear distinction between the two systems, which reveals the importance of this theme to public health management.

Health policy; Health care delivery; Health administration; Unified Health System; Prepaid health plans

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