Implementing regulation policy in Brazilian health care regulation centers.

The regulation of specialist medical appointments represents one of the problematic areas of the Brazilian Public Health System. In this regulation process, 2 issues stand out: 1) which patients should have the highest attendance priority, and 2) which service suppliers can best resolve the specific health problem of a patient? Based on the consideration of the existing Brazilian context in the field of medical assistance, this study proposes a model designed to aid regulation centers deal with the decisions related to the process of allocating specialist medical appointments. The model integrates multicriteria decision analysis and linear programming for the specialist medical appointment allocation, in which the allocation of patients is defined as a function of the relative significance of a set of criteria related to the notion of effectiveness of the specialist medical care and the capability of the accredited specialist health care units. The integrated model was implemented in a computer-based system and validated using cardiology and vein surgery data from the regulation center in Porto Alegre, Brazil. The validated computational system was applied to mammography services in another regulation center. The system successfully implemented a prioritization scheme, decreasing significantly the examination waiting time of severe cases.