Consórcios intermunicipais de saúde como política pública estruturante – Promoção do pacto federativo no sistema público de saúde nos municípios do estado do Tocantins

Abstract

This dissertation addresses the constitutional precept that health is a right of all and a duty of the State, contrasting this guarantee with the reality of technical, financial, and administrative precariousness in most Brazilian municipalities. Intermunicipal health consortia are institutional arrangements aimed at the shared management of common objectives that would be unattainable individually. Consortium management offers significant benefits such as economies of scale, rationalization of expenses, and the implementation of complex projects, such as the joint acquisition of medicines and the provision of medium and high-tech services, allowing small municipalities to overcome "assistance gaps" and organize regionalized care networks within the health system. The judicialization of the health system to guarantee medicines and hospitalizations generates legal and financial insecurity due to emergency expenses and disorganization in the budgetary planning of municipalities. Consortium management acts as a mitigation strategy because, by organizing the supply in a regionalized and agreed-upon manner, it reduces the need for litigation and promotes equitable access to the health system for residents.