Hortale AV, Pedraza M, Rosa GML. O accesso e a descentralização na análise de sistemas saúde. [ Access and decentralization in the analysis of health systems .] Saúde em Debate [ Health in Debate] (Rio de Janeiro, Brazil ) 2000; 24(56): 57-66.

Objectives: To deepen the analysis of the categories of access and decentralization, to propose them in developing a comparative analytic model of health systems, and to argue in favor of the existence of a relationship between both categories in the construction of the model.

Methodology: Analytic and interpretive.

Resultados: The authors present a detailed analysis of the concepts of access and decentralization. The authors consider the difference between availability and access, the relationship between the macro level of the health system (structures of financing and regulation, policies of distribution of resources and personnel) that makes possible or impedes the use of services by the population and the level of the offered services. Likewise, the authors analyze the individual and social factors that intervene in the accessibility of services. In relationship to the concept of decentralization, the authors analyze different definitions and conclude that a regulated and controlled process ought to respect the rhythm of state reform processes in each country and should respond to the geographic, demographic, economic, social, and cultural characteristics of each country.

Conclusions: The authors consider that the advantageous utilization of both concepts in a relational form within comparative studies of health systems is potentially advantageous due to the integrated character of both concepts and due to their wider utilization in analyses of health services. Since they permit temporal comparisons and present a certain variability in time and space both concepts integrate social and political dimensions.

Copyright 2007 University of New Mexico