Escassez e equidade na alocação de recursos públicos da saúde na pandemia da Covid-19: uma análise crítica do critério de equidade utilizado no âmbito do Maranhão

Abstract

For Rawls, the political conception of justice must be articulated in politically autonomous values and not as part of a "general" philosophical, religious or moral doctrine, even more so in a democratic society, consisting of free social and political institutions. In the contemporary debate about the allocation process, allocation criteria are the most relevant issue with regard to achieving equity. It starts from the assumption that health resources are scarce and there is no system capable of offering all patients the existing treatments. Thus, the present work intends to analyze the efficiency of the equity criterion in the allocation of health resources in the context of the Covid-19 pandemic in Maranhão, with regard to the distribution of ICU beds during this period. For this, the effectiveness of the right to health is evidenced in the face of resource allocation. Soon after, it presents how the allocation of resources in Brazil took place through the actions of the WHO, SUS and Brazilian legislation in this period. And, finally, the effects of unfair allocation regarding the COVID-19 pandemic in Maranhão are analyzed in relation to the distribution of ICU beds. Thus, the hypothetical-deductive method is used, in the case of an exploratory research, with a bibliographic survey and data on the subject, using, mainly, studies by John Rawls on the subject. It was found that Maranhão was in fourth place in the national ranking of states with fewer ICU beds offered. Until August 2020, the state of Maranhão had 820 ICU beds, of which 487 were offered by the SUS. When the consolidated proportion is taken, there is an average of 1.16 beds per 10,000 inhabitants, but the proportion when done only with the SUS offer is 0.69 ICU beds per 10,000 thousand inhabitants. With regard to the beds offered exclusively for the treatment of COVID-19, Maranhão had 393 beds, 228 of which in the public health network. As for the importance of this scientific work, it is believed that the research is necessary for the legal environment in terms of the social relevance it has on the allocation of resources in health, in order to avoid the propagation of the negative effects of the poor distribution of these resources. in the city of São Luís, as well as in the state of Maranhão. It is concluded, then, that the misallocation of health resources in Maranhão during the pandemic period necessarily triggers political, legal and philosophical assumptions on the subject.