Contractualisation of hospital management versus health regulation: agencies, state control and evaluation in SUS

• Autor(a) principal: Borges Souza Santos, Thadeu
• Data de Publicação: 2017
• Outros Autores: Cardoso de Matos Pinto, Isabela
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: https://doi.org/10.25761/anaisihmt.43

This article aims to reflect on the contractualisation of hospital management in Brazilian regulatory history in the light of evaluation as a relevant element for health management capacity. The contemporary international tendency of the State to assume a regulatory character implies its status as provider of social security, especially in the National Health Systems based on the Beverigian model. In the Brazilian case, the Unified Health System (SUS) was conceived in the re-democratization process, inspired by the Social Welfare State, and was legitimated in the Federal Constitution of Brazil in 1988. With the reformist waves of the 1990s, model of regulatory agencies, such as the National Agencies of Sanitary Surveillance and Supplementary Health. However, since the Administrative Reform of the State at the end of the same decade with the incorporation of Alternative Management Models, mainly aimed at hospitals, the regulatory activity was under the responsibility of the legal apparatus of external and internal control, notably the Court of Auditors, Public Ministry and SUS National Audit System. Conditions that reiterate the importance of health assessment, especially in the analysis of the governmental capacity to monitor, control and regulate its management contracts in hospital care. As a theoretical contribution, we adopt the Matusian epistemology, specifically on one of the vertices of the "Iron Triangle" that involves the control and evaluation of the manager's performance. This framework allows articulating the Brazilian regulatory capacity, the management capacity and the importance of the health evaluation, as opposed to the contracting of service management.