A regionalização e o acesso à saúde na região metropolitana de São Paulo durante a pandemia de covid-19 - anos de 2020 e 2021: uma análise intra e intermunicipal

Abstract

Introduction: The availability of healthcare services is one of the factors that has impacted people's survival during the COVID-19 pandemic. Studies demonstrate that, in Brazil, access to healthcare is profoundly influenced by the social characteristics of users and the location where they reside. Insufficient resources, difficulty in accessing healthcare, as well as the ability to travel with the best cost/benefit ratio to seek treatment, are determining factors in facing the disease. Objective: To study access to hospitalization in the Metropolitan Region of São Paulo (RMSP) during the first years of the COVID-19 pandemic - 2020 and 2021, and the influence of intra and inter-municipal travel for assistance on the disease outcome. Methods: An ecological, descriptive, quantitative study of COVID-19 cases hospitalized residents in the Metropolitan Region of São Paulo (RMSP) in the years 2020 and 2021. Outcomes of hospitalized cases (discharge or death) were analyzed considering the municipalities of residence and hospitalization, in the context of the regionalization of healthcare. Specifically in the city of São Paulo, a study of the flow of hospitalizations for COVID-19 cases residing in this city was conducted to verify whether the distance and travel time between the places of residence and hospitalization influenced the disease outcome. Results: A total of 264,638 hospitalizations of RMSP residents for COVID-19 were analyzed in 2020 and 2021. The majority of hospitalized cases were men, individuals of white race/color, with an average age of 57 years. The mortality rate was 1.44 deaths from COVID-19 per 1,000 inhabitants in 2020 and 1.95 in 2021. Approximately one-fifth of the cases were hospitalized in municipalities different from those of their residence, which varied among the various municipalities of the RMSP. There was no statistically significant difference in the COVID-19 case fatality rate, considering hospitalization in the same municipality of residence or in another municipality of the RMSP, as well as based on the distance and average travel time for hospitalization in the city of São Paulo. Conclusion: COVID-19 has prompted the need to create new protocols and generate a support network, especially for groups at higher risk and vulnerability, such as those geographically excluded. The development of a sustainable city requires a comprehensive understanding of access to healthcare, beyond the physical proximity of healthcare services to the place of residence, considering public policies that integrate various social sectors.