Home Care in Brazil: an exploratory study on the construction process and service use in the Brazilian Health System

Changes in demographic and epidemiological profiles, in Brazil and in the world, have brought the need to adapt the health care model. In this context, Home Care (HC) emerges as an alternative strategy of health care driven by several concerns: dehospitalization, rationalization of the hospital bed use, costs reduction, and the organization of patient-centered care. This study aims to analyze HC in the Brazilian Unified Health System, identifying the modalities of care and inequalities in service use. Thereby a documentary analysis of the legislation and secondary data available on the home care volume of services and procedures explorations were realized. In total, 94,754 home-based hospitalizations occurred in the 2008-2016 period, and 4,008,692 home-based outpatient procedures were carried out in the 2012-2016 period. Outpatient HC was more widespread, while home-based hospitalizations were concentrated in some geographical areas. The regional discrepancy is striking, revealing inequalities in supply, access, and use. Despite the legal framework, the establishment of a specific program, and volume of production, HC does not seem to be yet effectively incorporated as one of the apexes of the Health Care Network.