Regional and Macro-regional Dependency Index: A contribution to the SUS regionalization process

Abstract

The study addresses the interdependency between health regions and macro-regions in Brazil in 2019,  concerning both medium and high complexity  hospitalizations. The analysis of the flows established  was carried out using the Regional and Macro- regional Dependency Index, based on secondary data  provided by the Hospital Information System of the  Unified Health System (SUS). The results show that a  significant number of health regions and macro- regions absorb medium-complexity hospitalizations in their territories, varying according to specialties. In  high-complexity hospitalizations, most health regions  are highly dependent, assistance concentrated in 15%  of these. Among health macro-regions, the scenario is significantly heterogeneous: highly dependent on the North, Northeast and Midwest Regions, and highly  resolutive in the South Region. Analyses show that the population size of health regions and macro-regions  is inversely related to the regional and macro-regional dependency. The improvement of regionalization  requires an organized health care network, one that  takes into account territorial inequalities and  diversities, interdependency and autonomy among  the territories and actors involved, and inter-federative coordination, so as to provide care that is  both comprehensive and equitable.