O processo regulatório do acesso à oncologia clínica no Distrito Federal de 2022 a 2024: uma análise à luz do modelo dos múltiplos fluxos de Kingdon

Abstract

Introduction: In Brazil, healthcare regulation is a governance technology aimed at mitigating failures in access to the Unified Health System (SUS), executed within the Regulatory Complex through the National Regulation System. In the Federal District, clinical oncology is classified as a scarce and strategic service, requiring management by the Regulatory Complex. The relevance of this study lies in the need to investigate operational bottlenecks and compliance with legal frameworks in face of the care pressure resulting from the rising incidence and prevalence of cancer. Objectives: to analyze the regulatory process of access to clinical oncology in the Federal District from 2022 to 2024, from the theoretical perspective of Kingdon's Multiple Streams Model (MSM) and the National Regulation Policy. Specific objectives: to analyze the profile of operational outcomes, technical and structural non-conformities, response times, technological arrangements, the participation of actors in regulation policy, and the normative context to understand prevailing political forces. Method: A retrospective cohort of requests for first appointments in clinical oncology, in SISREG III, from January 1, 2022 to December 31, 2024, and a documentary analysis interpreted through Kingdon's Multiple Streams Model. The theoretical-methodological distinction resided in applying Kingdon’s MSM to interpret flow dysfunctions. Data were processed using Jamovi, software, with descriptive and inferential statistics, including binomial logistic regression to predict compliance and outcomes. Results: A total of 14,883 consultation requests were analyzed. Although the median regulator evaluation time decreased to 1 day in 2024 (95% CI 2.26 – 2.52), the users’ final access deteriorated, reaching a median of 80 days (95% CI 77.09 – 78.90). A critical “instructional blackout” was identified, where technical compliance varied drastically by entry point: the general hospital with clinical oncology showed a predicted probability of compliance ten times higher than that observed in emergency care units (UPAs)—0.1039 (95% CI 0.086 – 0.123) vs. 0.0105 (95% CI 0.003 – 0.032). Logistic regression demonstrated that requests originating from UPAs were 91% less likely to be compliant (OR=0.091, p<0.001). In Kingdon’s problem stream, the deficit of 5,176 vacancies and duplication rates (27%) reveal failures in traceability and network capacity. Conclusions: The findings suggest that the regulatory process in oncology in the Federal District shows a mismatch between the efficiency of technical analysis and real access to treatment. The convergence of Kingdon’s streams indicates that the “instructional blackout” and the shortage of vacancies serve as critical barriers that may compromise equity and comprehensiveness of care. It is concluded that the window of opportunity for improving oncology policy seems to depend on the qualification of primary care and the expansion of installed capacity, aiming for compliance with legal deadlines and reduction of vulnerabilities in the patient care pathway.