Challenges for Managed Care Regulations in the Organization of the Brazilian Healthcare System

Abstract

Introduction: Managed care regulation is a strategy for observation and ordering of the service network and user flow management. The steady increase in new specialized procedures due to developments in science and technology and the health services market, require dynamic planning and management focused on efficiency and effectiveness improvements. The identification of problems common to regulations can contribute to the practice of managers involved with this activity. Objective: to describe the main challenges faced by health care regulation. Material and Methods: This was an integrative review of the literature based on searches in SciELO databases. The topics "regulation of health systems and networks", "regulation of health services" and "regulation of health" without definition of filters, and with the option "AND" between the words of the subjects, were used. After reading the titles, a second screening was performed by reading the abstracts. Results: The following challenges were categorized: 1. limited offer of appointments and examinations in the care network. 2. Precariousness of reference and counter-reference. 3. difficulties in the organization of regulatory activities. 4. low usage / lack of protocols for referrals. 5. precariousness of information and communication systems. 6. significant political influence in the management of facilities. 7. disorganization of the service network. Conclusion: The challenges listed synthesize a strategic management agenda, which can assist managers in decision-making, monitoring and evaluation. DESCRIPTORS Regulation.Continuity of Patient Care.Integrality in Health.