PUBLIC POLICIES FOR CRITICAL PATIENT CARE AND THEIR IMPACT ON VULNERABLE POPULATIONS

Abstract

INTRODUCTION: Public policies for the care of critically ill patients play a fundamental role in the organization of health services, especially in high-complexity contexts such as intensive care units (ICUs) and urgent and emergency care services. In Brazil, these policies are mainly structured within the scope of the Unified Health System (SUS), aiming to ensure universal access, comprehensive care, and equity. For vulnerable populations—such as people living in poverty, older adults, Black and Indigenous populations, and residents of remote areas—these policies can reduce inequalities in access to intensive care, improve clinical outcomes, and decrease avoidable mortality rates. OBJECTIVE: To describe public policies for the care of critically ill patients and their impacts on vulnerable populations. METHODOLOGY: This is an integrative literature review. The search was conducted in national and international scientific databases such as SciELO, LILACS, and PubMed. Controlled descriptors from DeCS/MeSH were used: “Public Health Policies,” “Intensive Care Unit,” “Vulnerable Populations,” and “Health Equity,” combined using Boolean operators. Articles published between 2020 and 2025, available in full text, in Portuguese, English, or Spanish, and addressing public policies related to critical patient care and their social or population impacts were included. Duplicate studies, editorials, letters to the editor, conference abstracts, and articles not directly related to the proposed topic were excluded. RESULTS: Seventeen articles were analyzed. The studies reviewed showed that policies focused on regionalization of care, expansion of ICU beds, strengthening of urgent and emergency care networks, and adequate public funding contribute to improved access to intensive care. A positive impact was observed in reducing regional and social inequalities, especially when associated with clinical protocols and access regulation strategies. However, structural and human resource limitations persist in more vulnerable regions. DISCUSSION: The findings demonstrate that although public policies advance the promotion of equity, their effectiveness depends on proper implementation, monitoring, and continuous funding. Barriers such as territorial inequality, shortage of specialized professionals, and fragile infrastructure still compromise critical care for vulnerable populations. Integration between levels of care and improved management capacity are decisive factors for better outcomes. CONCLUSION: It is concluded that public policies for the care of critically ill patients have a significant impact on vulnerable populations, contributing to the reduction of health inequities. However, it is necessary to strengthen the implementation of these policies, with a focus on equity, expanded access, and improved quality of care, ensuring effective and humanized critical care for all.