Disponibilidade de leitos de UTI adulto no estado do Rio de Janeiro entre os anos de 2018 e 2023

Abstract

The capacity of Intensive Care Unit (ICU) beds is a significant factor in access to healthcare services. In Brazil, the health system is characterized by substantial disparities in access between its subsystems and by significant inequalities in service provision, which is notably concentrated and privatized, contrasting with the constitutional principle of universality. The state of Rio de Janeiro, despite having the largest hospital network in the country, exemplifies these contradictions, displaying historical disparities in bed distribution across its new health regions. This study aimed to analyze the evolution of the provision and distribution of adult intensive care beds in the state of Rio de Janeiro in 2018 and 2023, focusing on regional inequalities and the differences between the public and private sectors. The methodology employed two complementary approaches. The first consisted of a quantitative analysis of the installed bed capacity, using data from the National Registry of Health Establishments for December 2018 and 2023. This analysis considered existing beds, SUS beds (Brazil's Unified Health System), and allowed for the calculation of the per capita ratio of adult SUS beds. The second approach was dedicated to a documentary study of regional health planning instruments, analyzing the Integrated Regional Plans (PRI) and the Regional Action Plans for the Urgency and Emergency Network (PAR RUE) from the nine health regions. These documents were obtained from the portals of the State Health Department and the Bipartite Intermanagers Commission, with the aim of comparing official planning with the quantified reality. The results showed that between the analyzed years, SUS beds (Type I, II, and III) grew by 56.66% in the state, increasing the per capita provision from 0.66 to 1.04 beds per 10,000 inhabitants. However, significant regional inequalities persisted in 2023; the Northwest region had 2.72 beds per 10,000 inhabitants, while the Baixada Litorânea region had only 0.38 beds per 10,000 inhabitants—a sevenfold difference. The documentary analysis, in turn, revealed the undervaluation of bed shortages as a priority problem. Furthermore, the State Health Plan 2025-2027 establishes ambitious state-level goals that are disconnected from regional strategies. It is concluded that public policies are needed to correct the registration distortions highlighted by the data, along with actions that prioritize equity in access to overcome the historical inequalities in intensive care within the state.