Efeito da Lei 12.732/2012 no tempo diagnóstico-tratamento para câncer de mama em São Paulo, análise estratificada por quintil de privação material das redes regionais de atenção à saúde no SUS

Resumo

Law 12.732/2012 established a maximum 60-day deadline for the initiation of cancer treatment within Brazil's Unified Health System (SUS), applying a uniform rule across the national territory without mechanisms for territorial differentiation. This dissertation investigates whether the law's effect on the interval between anatomopathological diagnosis and treatment initiation for female breast cancer in the state of São Paulo is heterogeneous according to the territorial socioeconomic context, operationalized through quintiles of the Brazilian Deprivation Index (IBP). The theoretical framework articulates two converging traditions: the public policy management literature — which demonstrates how institutional arrangements and street-level bureaucracy shape effective policy implementation (Arretche, Lipsky, Lotta & Favareto) — and Latin American critical epidemiology — which emphasizes the social determination of health and the territorial production of outcomes (Breilh, Castellanos, Almeida Filho). This convergence grounds the positioning of inequality as an effect modifier rather than a confounding variable. The study employs a quasi-experimental Interrupted Time Series (ITS) design with individuallevel data from the Hospital Cancer Registry of the Fundação Oncocentro de São Paulo (N = 27,508 women, January 2008 through December 2019), distributed across 17 Regional Healthcare Networks (RRAS) classified into five deprivation quintiles. For each quintile, an independent ITS model was estimated using median quantile regression (τ = 0.5), with inference via cluster block bootstrap (R = 10,000). Results reveal a heterogeneous response to the law: the most deprived quintile (Q5) shows a significant immediate reduction in the diagnostic-treatment interval that survives Bonferroni correction (p = 0.0006), though without trend sustenance; Q4 exhibits the most complete response profile, with significance in both parameters — level and trend — and robustness across five alternative temporal windows; Q3 presents a fragile result, compromised by a temporal placebo test; and Q1 and Q2 remain inconclusive due to statistical power limitations. The non-monotonic pattern of responses — where detected significance does not follow a gradient proportional to deprivation level — is consistent with the thesis that each territory operates within distinct determination domains, where the same regulatory stimulus produces qualitatively different responses. The study concludes that the law's formulation exclusively at the general dimension — without mechanisms to accommodate particular differences across territories and singular variations in implementation discretion — constitutes a gap that the observed heterogeneity renders empirically visible.

Ficha do documento

Tipo

Dissertação

Ano

2026

Instituição

Fundação Getulio Vargas

Fonte

Repositório da FGV

Idioma

Português

Acesso

Acesso aberto

Identificador

oai:repositorio.fgv.br:10438/41246

Temas

Políticas PúblicasDesenvolvimento RegionalAdministração PúblicaSaúde

Palavras-chave

Câncer de mamaLei 12.732/2012Lei dos 60 diasSéries temporais interrompidasÍndice brasileiro de privaçãoDeterminação social em saúdeModificação de efeitoPolíticas públicas de saúdeBreast cancerLaw 12.732/201260 days lawInterrupted time seriesBrazilian deprivation indexHealth inequalitySocial determination of healthEffect modificationHealth policyAdministração públicaBrasil. [Lei n. 12.732, de 22 de novembro de 2012]Avaliação de resultados (Cuidados médicos)Sistema Único de Saúde (Brasil)Administração dos serviços de saúde - Brasil