From pressure to boldness: the conflict between decentralization and network management in SUS

• Autor(a) principal: Trevisan, Leonardo
• Data de Publicação: 2007
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Revista de Administração Pública
• Texto Completo: https://periodicos.fgv.br/rap/article/view/6585
• topic: SUS; state reform; public management; public policies; decentralization; health sector reform.; SUS; reforma do Estado; gestão pública; políticas públicas; descentralização; reforma do setor de saúde.

Taken into perspective, the implementation of the Unified Health System (SUS) has been facing managerial problems. First, because the increasing pressures for state reforms that will minimize costs affect the system¿s concept of universal care. Second, it is hard to balance the decentralization principle with the network concept, understood here not only as the link between different management spheres but also as how one can exercise his or her right in a network, from the planning stage on. On the other hand, operational decisions on healthcare were decentralized but the fund flow was not. Administratively speaking, the decentralization of healthcare management suffered an interruption when the Healthcare Operational Guideline n. 01/2001 came into effect. From the managerial standpoint, the introduction of the network concept, the strongest weapon against verticalization of the decision making process, faces operational and financial constraints (the implementation of electronic tokens) that keep the different organizations from ¿speaking the same language¿, which is the most effective way to create inter-organizational ¿bonds¿.