A descentralização regional do atendimento oncológico de alta complexidade é efetiva? Evidências da política estadual da Bahia

Abstract

Can a better geographic distribution of high-complexity public health services improve equity in access to treatment within Brazil’s Unified Health System (SUS)? This paper investigates the effects of decentralizing cancer treatment in the state of Bahia starting in 2016, with the establishment of a new high-complexity oncology unit in the Southwestern health macroregion. The objective is to assess whether the State Cancer Care Policy led to a significant increase in access to cancer treatment within the region itself. To this end, we use a panel dataset at the municipality of residence level from 2013 to 2020, sourced from the SIA and SIH/DATASUS systems. The study analyzes whether the new unit contributed to greater territorial equity in access to chemotherapy. We estimate a differences-indifferences model with multiple groups and time periods using administrative data. The results indicate that, following the expansion of chemotherapy treatment capacity, there was an approximate 20% reduction in the average distance traveled for treatment and a significant decline in the proportion of patients treated in the state capital (Salvador). These findings suggest that the regional expansion of cancer services improved local access to oncology care and helped reduce territorial health inequalities.