Uso corporativo do território por serviços de saúde e seus reflexos na pandemia de Covid-19 na região geográfica imediata de Imperatriz, Maranhão, Brasil

Abstract

This research aims to understand the corporate use of territory by health services in the Immediate Geographic Region of Imperatriz (RGII) and its effects during the Covid-19 pandemic. From this perspective, the study is based on the analysis of the distribution of medical-hospital services under the logic of territorial selectivity, the dynamics of patient mobility in search of care, and the spread of Covid-19 as a phenomenon that reveals and deepens pre-existing inequalities in the regional provision of healthcare. The temporal scope of the research encompasses the pandemic period from 2020 to 2022. The spatial scope is the RGII, as defined by the Brazilian Institute of Geography and Statistics (IBGE) in 2017, based on the functional centrality exercised by Imperatriz over the municipalities that comprise this regional unit. Methodologically, the research unfolded in two interrelated stages, a theoretical stage, focused on bibliographic review and conceptual construction, and a technical-analytical stage, dedicated to the systematization and interpretation of secondary data from official sources. The theoretical foundation drew on key authors for a critical understanding of territory and its selective uses, such as Milton Santos (1996), Maria Laura Silveira (2011), Rogério Haesbaert (2007a), Claude Raffestin (1993), Marcelo Lopes de Souza (2008), Lucas Labigalini Fuini (2017), David Harvey (2005b), among others. The empirical analysis was based on data from DataSUS, CNES, ANS, SIOPS, IBGE, as well as from the AMS/2005 survey and the Health Statistics report (2009). The results indicate that the selective distribution of resources, equipment, professionals, and health infrastructure intensifies compulsory patient mobility flows, exposing the fissures and contradictions in the regionalization of Brazil’s Unified Health System (SUS), as well as in the role of the State in organizing and ensuring the right to health especially in territories where service provision remains subordinated to centralizing and unequal logics. This configuration reinforces regional asymmetries in access to medium- and high-complexity services, while deepening the dependence of peripheral areas on the regional center. Such centralization reveals not only the fragility of SUS regionalization but also the inadequacy of public infrastructure in responding equitably to public health crises, resulting in continuous and unequal displacements of populations in search of care.