The National Health System, being named unique in the Constitution because it refers to a set of elements, such as universalization, equity, integrality, decentralization and popular participation and which is in convergence with the Constitution of 1988 of the Federative Republic of Brazil, which states that health is a right of all and a duty of the State.Thus, with the creation of SUS, the entire Brazilian population now has the right to universal and free health care , financed with resources from the budgets of the Union, the States, the Federal District and the Municipalities, as regulated by article 195 of the Brazilian Constitution. It is noteworthy that SUS is one of the most powerful and important in the world and it serves about 220 million people. It is characterized by a foundation of three pillars: universality, integrality and equity.
Roberta Bertagnoli Gasparo, Haroldo José José Torres da Silva
econômico: traz soluções para o mercado e estimula o debate frente ao "novo".Foi a partir do avanço do uso da internet de maneira global que os mercados eletrônicos alavancaram a tecnologia da informação para combinar compradores e vendedores de modo eficaz (Nian e Chuen, 2015).Soluções digitais para transações financeiras eliminam barreiras geográficas, estimulam o desenvolvimento tecnológico e reduzem a burocracia estatal sobre as transações comerciais, aliviando a carga
O presente trabalho tem como objetivo fazer uma análise inicial do fenômeno das criptomoedas, representadas, aqui, pelo Bitcoin, visto que é a pioneira e a que possui maior repercussão na comunidade jurídica atualmente. Analisa-se o tema a partir do desenvolvimento da globalização e da emergência de um Direito Global e Transnacional. Por fim, se discorre sobre duas possibilidades de regulamentação, quais sejam: (i) a criação de um tratado internacional, estabelecendo critérios às condutas dos usuários; (ii) a utilização de regras costumeiras, oriundas das relações entre os usuários, estabelecendo normas de conduta.
De forma acadêmica e construtiva, sem pretender esgotar o assunto, a presente pesquisa tem como objetivo realizar um estudo jurídico e econômico do bitcoin, que é a espécie de moeda virtual mais utilizada no mundo, mediante as ferramentas metodológicas da Análise Econômica do Direito, demonstrando como o uso de bitcoins nas transações realizadas pela empresa em recuperação pode reduzir os custos de transação e contribuir para uma recuperação judicial menos custosa, mais célere e mais eficiente, colaborando, ainda, para que a recuperação judicial cumpra os seus objetivos previstos no art. 47 da Lei n. 11.101/05, quais sejam, viabilizar a superação da situação de crise econômico-financeira do devedor, a manutenção da fonte produtora, bem como do emprego dos trabalhadores e dos interesses dos credores, promovendo, assim, a preservação da empresa, sua função social e o estímulo à atividade econômica
In Brazil, it is referred to as sanitary surveillance a complex state action that has undergone transformations since 1999, with the creation of the National Agency of Sanitary Surveillance (ANVISA) and the institution of the National Health Surveillance System (SNVS). Its area of activity covers the sanitary control of products and practices related to health, articulating to control some determinants, risks and damages to health. It represents an expressive part of health protection and, integrating the Brazilian Health System (SUS), contributes to its qualification, as well as national products submitted to sanitary regulation. In the organization of SNVS, notably in a federative country with continental dimensions and extremely diverse realities, such as Brazil, the decentralized implementation of actions and their correspondence with the loco regional context is fundamental. Being the municipality the most fragile component of the SNVS, it is imperative to study contextually the municipal services, and among them, the capitals, which concentrate resources, population and problems of various orders. This is an exploratory and descriptive study based on secondary and universal access data and covers sanitary surveillance services of the four state capitals of the southeastern region of Brazil, from 2014 to 2017, a year of reform of federal SUS financing. The capitals were characterized by sociodemographic and financial indicators and the respective sanitary surveillance services, using data from the Municipal Basic Information Survey, from the official sites and referring to their rates collection. The procedures reported by these services were described and their revenues and expenses analyzed. It was found that the sanitary surveillance of these capitals are inserted in different hierarchical levels in the organization chart of the respective SMS and that their financing is very dependent on federal transfers, which decreased in the period. The allocation of own resources was very low and amounts collected as fees and fines seems not to have been reverted to the service in one of the capitals that reported this collection. There was no uniformity in relation to the types of inspecteds establishments/activities and the licensing process. Data from the different databases were consistent. It is necessary elucidate to what type of regulation are being submitted the establishments and services located in the jurisdictional limit of the capitals and that are not regulated by them, and discuss responsibilities. As well as institutional and political factors, with the intention of explaining the non-allocation of own resources and those collected by the surveillance, or part of them, to the services themselves.
Abstract The implementation of a medical course in a city in the Brazilian northeastern region to expand and decentralize medical education as a result of the Project More Doctors for Brazil includes the institutionalization process that takes into consideration cultural and organizational aspects that facilitate or hinder the accomplishment of innovative practices. This study analyzed the implementation process according to key categories: pedagogical project, teaching-service integration, teacher development and infrastructure. The results showed facilitating elements and barriers that depend on the movement among the proposal’s instituted forces, instituting forces and the institutionalization process. A strategy for greater feasibility can be found in autonomous movements triggered by subjects who are committed to the objectives of the involved courses and institutions that work towards making legislations and intentions real.
Based on the principles of universality and equality and the guideline of integrality, the Brazilian Public Healthcare System, called Unified Health System (SUS), was constituted as a regionalized and hierarchical services network. There is the recognizing of interdependence between municipalities and between levels of government to guarantee the provision of services. The Union and the states share with the municipalities the responsibility for guaranteeing the constitutional right of access to health goods and services in the country, increasing the requirement for actions cooperation and coordination between the three levels of government. To respond to these questions, intergovernmental relations have undergone progressive transformations since the creation of the system. Recently, in a context of reducing federal social spending, the demand for lesser Union regulation has increased, with changes in federal funds allocation. In the light of the institutional trajectory of the last three decades, as well as the literature on decentralization in health and federalism and social policies, the text has the aim of analyzing the change occurred in 2017 in the form of federal transfers in the SUS. Considering these contributions, the study stresses that the results of decentralization may be negative for efficiency in management and for equity in access to health services. It also emphasizes the relevance of coordination arrangements and mechanisms to improve the health policy outcome and effectiveness in system management. Analyzing the worsening of the financing of the SUS, with a probable reduction of the participation of the Union in the allocation of health resources due to the freezing of its minimum application by EC 95, the study points to the risk of transferring greater responsibilities to states and municipalities, already undermined by underfunding in the health area. Consequently, this changing can cause a reduction in the coordination capacity of the system, a loss of effectiveness, an increase in competition and fragmentation, and an increase in the inequality of access to health goods and services in the country.
Adelyne Maria Mendes Pereira, Luciana Dias de Lima, Cristiani Vieira Machado
This article discusses the processes of de centralization and regionalization of health policy in Brazil and Spain between 1980 and 2015. The study was developed with contributions of the historical institutionalism and of the historical com parative method, by means of three dimensions of analysis: State context; trajectory and institution ality of the decentralization and regionalization of health; and constraints. The study showed that,in both countries, the more general context of re-democratization and decentralization of the State conditioned the reforms of health systems and their political-administrative organization. In addition, historical, institutional and political factors have had a specific impact in each case, influencing the regional organization of services, the balance of power and the division of responsibilities between the governmental spheres in the management, financing and coordination of health policy. The study suggests that the way these factors interrelated over time is important for understanding the decentralization and regionalization of health systems in different contexts.
José Carvalho de Noronha, Gustavo Souto de Noronha, Telma Ruth Pereira, Ana Maria Costa
This article reflects on the future of the Brazilian Unified Health System (SUS, acronym in Portuguese), based on the foresight exercises conducted by the Brasil Saúde Amanhã initiative of the Oswaldo Cruz Foundation. The text briefly reviews some paths followed by the SUS as referred to in the Federal Constitution of 1988. It highlights the movement towards the decentralization of care and the constraint of health financial resources that reduced policies of increasing public expenditures. It examines the public and private arrangements for financing and provision of services that have resulted in sectoral privatization, mainly from economic policies articulated with concession of fiscal benefits. It analyzes the changes in the public sector financing through successive constitutional amendments that resulted in the weakening of established social protection policies, particularly of the health sector. For the future, the text considers population aging and analyzes trends in the epidemiological profile, with consequent changes in the health care paradigm. The article concludes by pointing out the consequences of fiscal strangling in the organization of the healthcare system and the need to reverse legal provisions that hamper the fulfillment of the constitutional mandate for equity and universality.
Marcelo Battesini, Carla Lourenço Tavares de Andrade, Marismary Horsth De Seta
Health Surveillance carries out a set of actions to prevent health risks related to the consumption of products and the provision of services under the Unified Health System (SUS). The implementation of Health Surveillance actions relies heavily on the federal funding policy, which induces its decentralization. This text aims to analyze the federal funding of Health Surveillance to States and Municipalities from the scheduled onlendings in the period 2005-2012. Among the main results are the increase of per capita values, steady at around the mean value of R$ 1.25/inhabitant/year; the increased number of municipalities that agreed to carry out strategic actions; and a stable trend in the proportions of each federated entity at around 50% to Municipalities, 25% to state federated entities and 20% to the Central Public Health Laboratories (LACENs). Results show that the adoption of unified nationwide per capita values caused distortions that indicate inequity among state territories, pointing to the need to clarify the concept of equity in financing under the National Health Surveillance System and to broaden the discussion on the currently used allocation criteria.
Lucília Nunes de Assis, Eliete Albano de Azevedo Guimarães, Juliana Vaz de Melo Mambrini, Filipe Curzio Laguardia · 7 authors
Introduction: The Health Surveillance Strengthening Project implemented in 2012 in Minas Gerais -subsidized by a local diagnosis- aimed at decentralizing Health Surveillance. Objectives: To characterizes the local Health Surveillance services in the state of Minas Gerais in 2014. Method: Descriptive study that analyzed 527 (62%) out of a total of 853 counties. The common variables to the Health Surveillance areas were instruments of management, financing, professional category, qualification and information system. Specific variables to the Health Surveillance areas were characterized infrastructure, reference services and actions. Frequencies, medians, interquartile differences and Spearman’s coefficient (p< 0.05) were analyzed. Results: An association among mana-gement tools, availability of professional categories, information system and population size (p<0.001) was observed. Insufficient infrastructure in the Sanitary and Environmental Surveillance and predominance of programmatic actions against monitoring actions were observed. Conclusions: The challenge of Health Surveillance demands confrontations in the field of management, practices and financing.
This paper considers how financing, institutions, and metropolitan cooperation play into the provision of public services, specifically healthcare and education, in the Metropolitan Region of Campinas (RMC). Given that the municipal level of government is often too small to effectively provide public services, especially in the context of extensive decentralization, I argue that the metropolitan level of aggregation, for reasons including greater economies of scale, more efficient delivery of services and regional equity, constitutes a more relevant unit of service provision. The recent emergence of the Agência Metropolitana de Campinas (Agemcamp) offers the possibility for achieving greater metropolitan cooperation, leading to improved public services in the RMC.
Banque Interaméricaine de Développement, Banco Interamericano de Desenvolvimento
This Breve is based on the original thesis work and on a webinar presented by Dr. Fábio Ferride-Barros regarding the "Ethics of Health Resources Allocation in the Publicly Financed Health Care System in Brazil." The perspective offered in this Breve complements a previously published issue documenting the use of health technology evaluation in decision-making in Brazil's health sector (IDB, 2015). The Breve introduces the challenges of priority setting in the context of a large and decentralized national universal health care system, which confronts resource scarcity and substantial inequalities.
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Public Health in Brazil
Health Systems, Economic Evaluations, Quality of Life
Jovana Gardinali Malagueta, André Luiz Bigal, Érika Valeska Rossetto
Because of the decentralization of the management of public health and the absence of a reform of its financing, the municipalities started to significantly increase the volume of its own funds invested in this area. In this context, this study aimed to analyze the participation of federal entities - Federal, State and Municipalities - the financing of the Unified Health System (SUS) in the municipalities with 50,000 to 100,000 inhabitants, the Metropolitan Health Region of Campinas, from 2012 to 2014. An integrative literature review and survey data were carried out on the municipalities on the Public Budget using the Health System information. Seven articles were selected and analyzed in full. In relation to the data collected, it was found out that municipalities, state and Union fulfilled what determines the Law n° 141/2012; the three federal entities increased health expenses from one year to another; there was an increase of municipal resources at the local health expenditure and a decrease of Union involvement, and the participation of the State wasn’t significant enough. Thus, health financing, by the Union needs to be corrected and should state resources participate in a more significant way, being extremely necessary discussion of new sources of resources to allow more public investment increase in health.
This thesis discusses how the Brazilian federalism promoted, from 1997 to 2014, initiatives to develop state capacity in municipalities. This theme was taken up on the federal agenda in the first government of Fernando Henrique Cardoso (1995-1998), continued during the two terms Lula (2003-2010), and finally, in the initial mandate of Dilma Rousseff (2011-2014). The decentralization of policies started in 1988 constitutes the political and institutional context which demands to modernize its management. It's presented how evolved the managerial and administrative qualification in the cities to situate the challenges of Brazilian cooperative federalism to support these level of government. This research was organized in three theoretical dimensions and analyzed five cases. The first dimension deals with the cooperation through territorial cooperative arrangements, regarding the Federal Joint Commitee (CAF), installed in 2003, as the object of analysis because brought together representatives from federal government and from municipalist associations. One of its fields of action was the developing of municipal state capacity. The second dimension addresses the federative cooperation by means of policy systems. It was compared the Unified Social Assistance System (SUAS), created in 2005, with the education policy, that is devoid of such systemic intergovernmental arrangement. In the education the analysis rests with Articulated Action Plan (PAR), instituted in 2007. The SUAS has a wide legislation and normatization aimed for municipal entities in which highlight demands to modernize the local bodies responsible for this policy. The goal is to compare if policy systems are more effective to promote state capacity than other kinds of federative relations. The third theoretical dimension concerns to federal programs generated to support the qualification in municipalities.The goal is to compare if policy systems are more effective to promote state capacity than other kinds of federative relations. The third theoretical dimension concerns to federal programs generated to support the qualification in municipalities. Were selected two programs: the Program of Management Modernization and Tax Administration and the Management of Basic Social Sectors (PMAT), administered by the BNDES since 1997, and the National Program of Support to the Administrative Modernization and Fiscal of Brazilian Municipalities (PNAFM), managed by the Ministry of Finance and the Federal Saving Bank (Caixa Econômica Federal) since 2001. The analysis in the three dimensions shows that, considering the comparative experience in international level, and the literature about federalism and intergovernamental relations, before the manner how were organized the territorial cooperation and the implementation of federal programs in Brazil, both modalities are not viable routes to further the modernization in municipalities. The research concludes that a national and articulated policy system, both for theoretical and empirical reasons, is the most appropriated type of federative cooperative institutionality to promote state capacity in the municipalities in realities such as Brazil. In this line, in the final of the Tesis it's proposed a analytical model that considers articulated policy systems as the most adequate model to deals with this federative challenge in a setting featured by the decentralization of policies, but that at the same time lives with a great heterogeneity and inequality of state capacity among local governments.
A revolução tecnológica na área da computação e da Internet trouxe modificações importantes nos mais variados setores da sociedade. Atualmente, a maioria das transações financeiras ocorre virtualmente, nesse contexto surgiu a moeda digital Bitcoin. O conceito desta moeda foi introduzido em 2008 e pode ser descrito como a primeira criptomoeda descentralizada do mundo. As transações em Bitcoin ocorrem sem a necessidade de um intermediário e não dependem da confiança em nenhum emissor centralizado ou instituição financeira. Ao longo deste trabalho serão expostas as características, o funcionamento, as vantagens e desvantagens desta nova moeda, contrastando-a à moeda tradicional de cunho forçado. O objetivo principal é observar se essa nova tecnologia pode ser uma alternativa concorrente aos meios tradicionais, até o ponto de substituir por completo as moedas usadas nos dias de hoje, centralizadas em bancos centrais, ou se a criptomoeda será uma aliada cooperativa à moeda tradicional. Conclui-se que o Bitcoin é no curto e médio prazo uma moeda paralela, ou seja, que coopera e é aliada aos meios tradicionais.
Análise da capacidade de autofinanciamento e da dependência financeira dos municípios fluminenses para custear o gasto municipal no Sistema Único de Saúde (SUS). Estudo descritivo, seccional e analítico com dados do Sistema de Informações sobre Orçamentos Públicos em Saúde (Siops). A receita per capita própria municipal foi utilizada como medida da capacidade de autofinanciamento. O Índice de Capacidade de Autofinanciamento (ICA) permitiu o ordenamento dos municípios por graus de capacidade de autofinanciamento. As medidas estatísticas utilizadas foram a média, desvio padrão, intervalo de confiança e o coeficiente de correlação de Pearson. Os valores de receita e gasto em saúde foram deflacionados pelo Índice Geral de Preços (IGP-DI). Os resultados evidenciaram que houve aumento da capacidade de autofinanciamento entre os anos de 2002 e 2013, com decréscimo a partir de 2014. Na distribuição por graus de capacidade de autofinanciamento identificou-se entre os aos 2002 e 2008 uma continua ascensão dos municípios para graus mais elevados e, a partir do ano de 2009 em diante, todos se encontraram no grau 4, demonstrando maior aproximação das receitas municipais. Por outro lado, verificou-se permanência de desigualdades de receita própria para gasto em saúde. Houve elevação da despesa total em saúde durante todo o período com participação dos dois subcomponentes de receita (receita própria e de transferências SUS) neste crescimento. O gasto próprio deteve a maior participação na despesa total em que pese a relevância das transferências SUS, em especial da União, onde 80 por cento dos municípios apresentaram uma dependência de recursos de transferências do SUS acima de 20 por cento na execução de sua despesa total em saúde
In recent years, global governance institutions have operationalized their commitment to the right to health by advocating for universal health coverage (UHC) – particularly in the Global South. UHC aims to develop health systems that are efficient, well staffed, and capable of providing affordable and appropriate medical care and essential medicines to rich and poor alike (World Health Organisation, 2014). The political priority afforded to this goal is driven by an acknowledgement that people in wealthy and poor countries alike are priced out of the “market” for health care. This has caused concern because of the negative economic effects associated with inadequate access to care. Academic research and scholarly rhetoric often justifies UHC on the grounds that it will strengthen the economic position of households (particularly households living below or just above the poverty line) and contributes to the growth prospects of national economies (World Health Organisation Commission on Macroeconomics and Health, n.d.). UHC is thus framed as an investment in human capital: Healthier citizens are more productive citizens. They are more capable of investing in their own well-being, and that of their dependents, through participation in the labor market rather than relying on public assistance. Why is it problematic to justify UHC, and health promotion more generally, on the basis of its economic value, that is, on the basis of the contributions it makes to growing markets and improving economic productivity? Research on the reconfiguration of welfare regimes in the Global North suggests that globalization is undermining their social, political, and economic foundations. These countries – much like their counterparts in the Global South – are experiencing a rise in unemployment, coupled with an increase in flexible and precarious work. Globalization has also been associated with an increase in human migration from the Global South to the Global North and within the Global South. As a result, states are simultaneously faced with increased demands for welfare from the unemployed and the working poor, an erosion of their tax base, and increasingly heterogeneous societies. States are responding to these changes by adopting welfare policies that expand the influence of market actors and market logics on social welfare. Consequently, decisions about how to define and promote the public good are increasingly made in a decentralized fashion by private actors operating in households or markets rather than in democratic political institutions. For example, in many countries, access to public assistance is now contingent on welfare recipients' efforts to find employment (i.e., the shift from welfare to “workfare”) and pay for basic services, on private and public sector providers' ability to provide social services efficiently and cost effectively, and on the state's ability to efficiently coordinate interactions between citizen consumers and social services providers (Roche, 2002). Advocacy for UHC reflects these political and normative shifts. It de-emphasizes the importance of collective democratic decision-making about how the health needs of populations should be addressed. Instead, public institutions are primarily responsible for solving a “technical” problem: financing health consumption for all. As public institutions become more focused on policing health financing, they reduce the services they provide and, in so doing, strengthen the market power of private players (Global Health Watch, 2014). Private actors – philanthropic foundations and for-profit providers of medical services, health insurance, and medicines – now routinely constrain the ability of governments to decide the terms on which the right to health should be advanced. Their influence is legitimated by the World Bank and IMF austerity policies that frame debt repayment and economic growth as the direct and primary responsibilities of democratic governments. Although governments in the Global South are particularly vulnerable to these pressures, similar pressures are present in the Global North – as demonstrated by private sector opposition to Obamacare (Kirsch, 2013) and patent law reform in South Africa (De Wet, 2014). In contrast, these institutions frame the obligation to promote the social dimension of citizenship as something that can be outsourced to private actors and/or achieved through market logics. Additionally, the value of social policies is often justified in economic terms, for example, in terms of their ability to improve the productivity of worker citizens and the revenues of public and private sector service providers. This discourse de-emphasizes the intrinsic value of formal and substantive equality and meaningful participation in collective decision-making about the public good. Political institutions feature in it primarily as mechanisms that mediate the efficacy of investments in health care. Their significance is determined by their ability to maximize returns on investments in health (Jack and Lewis, 2009). What are some of the consequences of advancing the right to health in this manner? Research shows that the shift from universalistic welfare regimes to regimes that target “especially vulnerable” or “especially deserving” populations undermines social solidarity by stigmatizing welfare recipients as people who violate the liberal ethos of contemporary welfare states. Vulnerable populations (e.g., non-citizens, people of color, indigenous peoples, working class women, and able-bodied unemployed people) are stigmatized as being reluctant to (or incapable of) succeeding in market societies on their own “merit” and as unfairly benefiting from welfare policies that advance their particularistic group interests rather than overall well-being (Brown, 2003). The low social status of these groups obstructs their ability to access appropriate and effective medical care, even when it is available at no or little cost to patients (Bassett, 2015). Globalization is a politically and socially mediated process. The harmful effects of globalization on social inclusion, and the limits of the policy responses to these dynamics, point to the urgent need for collective action and research aimed at addressing the dimensions of globalization that undermine the social determinants of health by privatizing, stigmatizing, and instrumentalizing the management of health – and in some cases, life itself. Collective action is needed to democratize decision-making about health care at the local, national, and global levels in a meaningful way to foster social solidarity and address status inequalities that lead to disproportionate rates of illness and death among stigmatized social groups and to politicize the priority placed on economic growth, given its sometimes harmful effects on human and planetary health. Global Challenges is a journal that welcomes scholarly contributions on these tough issues and insightful commentary that points toward strategies for addressing them.
<strong>Background</strong> Regional-based Integrated Healthcare Networks (IHNs) have been promoted in Brazil to overcome the fragmentation due to the health system decentralization to the municipal level; however, evaluations are scarce. The aim of this article is to analyse the content of IHN policies in force in Brazil, and the factors that influence policy implementation from the policymakers’ perspective. <strong>Methods</strong> A two-fold, exploratory and descriptive qualitative study was carried out based on (1) content analysis of policy documents selected to meet the following criteria: legislative documents dealing with regional-based IHNs; enacted by federal government; and in force, (2) semi-structured individual interviews were conducted to a theoretical sample of policymakers at federal (eight), state (five) and municipal levels (four). Final sample size was reached by saturation of information. An inductive thematic analysis was conducted. <strong>Results</strong> The results show difficulties in the implementation of IHN policies due to weaknesses that arise from the policy design and the performance of the three levels of government. There is a lack of specificity as to the criteria and tools for configuring and financing IHNs that need to be agreed upon between involved governments. For their part, policymakers emphasize the difficulty of establishing agreements in a health system with disincentives for collaboration between municipalities. The allocation of responsibilities that are too complex for the capacity and size of the municipalities, the abandonment of essential functions such as network planning by states and the strategic role by the Ministry, the ‘invasion’ of competences among levels of government and high political turnover are also highlighted. <strong>Conclusions</strong> The implementation of regional-based IHN policy in Brazil is hampered by the decentralized organization of the health system to the municipal level, suggesting the need to centralize certain functions to regional structures or states and to define better the role of the government levels involved.
This study characterizes as an exploratory qualitative case study, with the aim of analyzing the foundations of federal and state funding in Primary Healthcare of the municipalities of the state of Bahia, bringing light upon current conflicts after the deployment of the Pact for Health as well as the uncertainties that surrounded its funding. Data were collected in two stages, the first semi-structured interviews were conducted with closed and open questions, applied to current managers of the State Council of Municipal Health Secretaries of the State of Bahia (BA-COSEMS/ Conselho Estadual dos Secretrios de Sade-BA), in the second stage, it was developed a document review, through reading and analysis of ordinances, resolutions, state and federal, as well as minutes of meetings of the Managers Bipartite Commission (Comisso Intergestores Bipartite-CIB), which dealt with the theme Politics and funding of primary healthcare. It was observed that the issues, in relation to health financing, particularly Primary Healthcare, persist even after the institution of the Pact for Health. Therefore, it was concluded that decentralization will succeed when the amount of financial resources needed to meet commitments assumed to serve the population is adequate, and also when there is regular funding, increased resources for health by the three spheres of government. It is estimated to be necessary to discuss the
Michele Gragnolati, Magnus Lindelöw, Bernard F. Couttolenc
Discusses the extent to which reforms have transformed the health system, focusing on the expansion and reorganization of service delivery, financing of health services, and governance and accountability arrangements of the Brazilian Unified Health System (Sistema Único de Saúde, SUS). The reforms envisaged a fundamental transformation, with universality, equity, integration, decentralization, and participation as key principles. Significant progress has been made, in that the capacity to deliver services has expanded, regional disparities in the availability of services have been reduced, primary health care has been strengthened, most of the responsibilities for delivering services have been decentralized to municipalities, government health expenditures have increased, and various institutional mechanisms and innovations have been introduced to enhance coordination, participation, and efficiency. The SUS reforms also triggered several initiatives aimed at increasing and stabilizing public financing for health. Important challenges for the future include intergovernmental finance and coordination and the evaluation and consolidation of models for contracting, integrating, and delivering health services.
Víctor B. Penchaszadeh, Francisco A. Leone, Mario Rovere
The modern health system of Argentina was developed in 1945-1955, a period of economic bonanzacharacterized by industrialization, rapid urbanization and activist labor organizations. During the ensuingyears it evolved in three sectors: public, social security and private, with separate services, populationcoverage and funding. While the national Ministry of Health is nominally responsible for general healthpolicies and regulations, overseeing the general operation of health services, designing preventive medicineprograms and negotiating the coverage and fees of health insurance plans, it has in fact very low leverage toenforce decisions in the provinces, which are autonomous, as well as in the social security and private sectors,which are weakly regulated if at all. While the health workforce, medical facilities and level of spending areacceptable, the fragmentation and segmentation of the system render it highly inequitable and inefficient.During the 1980s and 1990s, the health system has experienced further transformations, as neoliberalpolicies took hold in the country and dictated a reduction of state involvement in social services in favor ofprivatization and decentralization of health care. The result has been increased fragmentation, inequity andinefficacy, as health care is increasingly prey to the economic interests of private corporations (insuranceand pharmaceutical industries), trade union bureaucracies and the medical professional and technologyestablishments. The expectation of popular sectors of society are that progressive polices recently enactedby Congress, and being implemented in the fields of education, retirement pensions and the media, will befollowed with much needed public health policies based on equity and efficiency.
Open access
Public Health in Brazil
Healthcare Policy and Management
Health Systems, Economic Evaluations, Quality of Life