Policy, primary care and access to Medium and High Complexity services in small municipalities

The article analyzes the referral of patients from small municipalities to medium or high complexity health services. In the small municipalities, political institutions related to patronage and bossism interfere in the forwarding of patients, being considered important to question how these institutions condition the access of family health’s patients from small municipalities to those services. A qualitative case study was conducted, using the reference of the historical neo-institutionalism, interviews, non-systematically observation, documentary analysis and quantitative data about the service network and the population. The results have shown that the insufficient supply of services facilitates their clientelistic intermediation.