[Notes for studying primary care within the context of segmented health systems].
This paper discusses the contribution of the concept of governance, combined with traditional approaches to primary health care (PHC) analysis, in a multicentre study covering Argentina, Brazil, Paraguay and Uruguay. Considering health systems variety of configurations and their segmented context, it aims to compare PHC implementation and performance characteristics in each country so as to explain them according to different determinants and compare them to governance models. Each countrys segmented context is presented, identifying public, private and social insurance sub-sectors arrangements. The PHC concept and its potential role in reorganizing equity- and access-based health systems are discussed. Five dimensions for PHC study are then defined: stewardship, financing, resources, comprehensiveness and intersectorality. Governance analysis revealed state-society relationships and is thus proposed as a tool for understanding such dimensions dynamic relationships.
Bursztyn
Ivani
I
Facultad de Medicina, Universidad Federal de Rio de Janeiro, Brasil. ivani@iesc.ufrj.br
Kushnir
Rosana
R
Giovanella
Lígia
L
Stolkiner
Alícia
A
Sterman-Heimann
Luiza
L
Riveros
Maria I
MI
Sollazzo
Ana
A
D001118:Argentina; D001938:Brazil; D003659:Decision Making, Organizational; D003695:Delivery of Health Care / Q000458:organization & administration; D006076:Government; D006296:Health Services / Q000191:economics; D006297:Health Services Accessibility; D006298:Health Services Administration; D006302:Health Services Research / Q000379:methods*; D010239:Paraguay; D011057:Politics; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration*; D012923:Social Class; D012935:Social Justice; D014583:Uruguay