[Expansion of access to specialized care: the experience of Regional Health Consortia in Bahia, Brazil].

The objective was to analyze the implementation process and the effects of health consortia in Bahia, Brazil, on access to specialized care. A qualitative study of multiple cases was carried out in three health consortia implemented in different regions of Bahia. Data collection took place between July and November 2022 and involved document analysis and 51 semi-structured interviews with state, regional, and municipal managers. The content analysis was guided by the theoretical-logical model developed for the research. The implementation of the consortia was made possible by the strong leadership of the state government and by financial incentives, which allowed the strategic management of political conflicts with the municipalities. The strategy resulted in a significant expansion of the offer of specialized services, reducing dependence on contracting private services and referrals to the capital. However, important challenges persist for the integration of the network, such as the incipient articulation with primary care, the high rate of absenteeism (30%) and the difficulty of adapting the portfolio of services to local and regional demands. The Bahian experience demonstrates that the formation of consortia is a powerful strategy to expand the supply of specialized care, overcoming political barriers through incentives and negotiation. However, the transition from a fragmented model to a truly integrated care network requires additional investments in care coordination, care regulation, and governance mechanisms that articulate the different points of care in a cohesive and patient-centered system. The expansion of supply, in itself, is a necessary condition, but not sufficient, to guarantee the integrality of care.