Home Care in Brazil: an exploratory study on the construction process and service use in the Brazilian Health System

Abstract Changes in demographic and epidemiological profiles, in Brazil and in the world, have brought the need to adapt the health care model. In this context, Home Care (HC) emerges as an alternative strategy of health care driven by several concerns: dehospitalization, rationalization of the hospital bed use, costs reduction, and the organization of patient-centered care. This study aims to analyze HC in the Brazilian Unified Health System, identifying the modalities of care and inequalities in service use. Thereby a documentary analysis of the legislation and secondary data available on the home care volume of services and procedures explorations were realized. In total, 94,754 home-based hospitalizations occurred in the 2008-2016 period, and 4,008,692 home-based outpatient procedures were carried out in the 2012-2016 period. Outpatient HC was more widespread, while home-based hospitalizations were concentrated in some geographical areas. The regional discrepancy is striking, revealing inequalities in supply, access, and use. Despite the legal framework, the establishment of a specific program, and volume of production, HC does not seem to be yet effectively incorporated as one of the apexes of the Health Care Network.

摘要：人口与流行病学特征在巴西乃至全球范围内的变化，使得医疗服务模式亟需革新适配。在此背景下，家庭护理（Home Care, HC）作为替代性医疗服务策略应运而生，其催生动因涵盖非住院化目标、病床使用合理化、成本管控以及以患者为中心的照护体系构建。本研究旨在分析巴西统一医疗体系（Brazilian Unified Health System）下的家庭护理服务，明确其服务类型与服务使用中的不公平性问题。为此，本研究针对相关立法文件以及可获取的家庭护理服务量、诊疗项目开展情况的二手数据开展了文献分析。2008至2016年间，累计完成94754例家庭住院服务；2012至2016年间，则开展了4008692例家庭门诊诊疗项目。家庭门诊护理的覆盖范围更为广泛，而家庭住院服务则集中于部分地理区域。区域差异十分显著，暴露出服务供给、获取与使用层面的不公平性。尽管已具备相应法律框架、专项项目设置以及一定的服务规模，家庭护理似乎仍未被有效纳入医疗服务网络的核心组成部分。