GOVERNANÇA DA REGULAÇÃO DO ACESSO HOSPITALAR EM SISTEMAS PÚBLICOS DE SAÚDE:

AUTORIDADE, DECISÃO E DESEMPENHO EM UMA REVISÃO DE ESCOPO

Abstract

Introduction: The existence of regulatory centers, protocols, and information systems does not, in itself, ensure that authority over hospital access is effectively centralized. In public health systems, decision-making may remain distributed among regulators, managers, and healthcare providers, raising a governance issue related to priority setting, control over healthcare capacity, and the implementation of regulatory decisions. Objective: To map and analyze how the governance of hospital access regulation has been structured in public health systems, with an emphasis on organizational models, decision-making authority, prioritization and allocation, coordination among actors, hospital capacity, technological mediation, and access performance. Methods: A scoping review was conducted according to the Joanna Briggs Institute methodology and reported in accordance with PRISMA-ScR and PRISMA-S. Searches were conducted in September 2026 in MEDLINE/PubMed, Embase, Scopus, Web of Science Core Collection, LILACS/BVS, and SciELO, with no restrictions on publication date or language. A total of 9,831 records were identified; after the removal of 4,744 duplicates, 5,087 unique records were screened. Data were extracted using a standardized instrument, and the synthesis was organized into six analytical dimensions. Results: A total of 31 sources of evidence were included. The synthesis showed that the institutionalization of centralized structures does not necessarily imply the concentration of decision-making authority, with arrangements in which healthcare providers, regulatory structures, and other actors share or influence decision-making and the allocation of hospital resources. The interdependent components of governance that emerged were information quality, prioritization, regulatory authority, capacity effectively subject to regulation, allocation, provider response, and hospital admission. The findings also highlighted the role of Internal Regulation Centers, interorganizational coordination, and information systems in linking hospital capacity to access. Conclusion: The governance of hospital access regulation extends beyond the formal existence of regulatory centers, protocols, and technologies and depends on the integration of authority, information, capacity, coordination, and the implementation of regulatory decisions. The synthesis supports a process-based analytical framework in which regulatory performance is examined from demand qualification and prioritization through allocation, provider response, and hospital admission, shifting the focus of assessment from formal structures to the capacity to produce legitimate and traceable decisions that are effectively translated into hospital access.