This essay aims to highlight the relationship between regional inequality of access to specialized public health care in Brazil and the bureaucratic structure of the Single Health System; a look at the Brazilian public health management in the light of the theory of bureaucracy. In this sense, themes about the subject were approached, where perspectives about bureaucracy, Brazilian public management, the shortage of professionals and the distribution of resources, as well as the difficulties generated to the population when citizens cannot access the public health service, were evidenced. Evidence was identified that leads to two paths, being that of citizens from urban centers and that of citizens from the interior, having this due to regional inequality established by the precariousness of management that leads to a poor distribution of resources. The shortage of medical specialists is present in both paths, being a serious problem caused by the bureaucratic processes of training and fixing these professionals.