Opportunities, drawbacks and justifications: outpatient care regulation’s decentralization in the city of Rio de Janeiro

Abstract

Since 2012, the city of Rio de Janeiro has the innovation on the national scene of having the
regulation of access to specialized care made by physicians in Primary Health Care (PHC). This article analyses the technical-political process that produced outpatient regulation decentralization to PHC: its motivations and context, actors, stakes, decisions and ramifications. Produced from interviews with managers, the material was analyzed having as main reference the public policies’ cycle of Howllet and Ramesh, so that its steps inspired the categories adopted in the article. The movement to decentralize outpatient regulation was based on dissatisfaction with outpatient access. In a context of strengthening the PHC, disputes for the control of care resources and using the care coordination as a discursive element, the model enabled greater role for PHC in access’ regulation. Nonetheless, some ‘successes’ are not exclusive reflections of decentralization for PHC, and negative consequences arise. From the adoption of evaluation processes, it is possible to create other regulatory arrangements in a model that remains promising.