Sistema Único de Saúde: de que sistema se trata?
Autor(a) principal: | |
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Data de Publicação: | 2006 |
Tipo de documento: | Tese |
Idioma: | por |
Título da fonte: | Biblioteca Digital de Teses e Dissertações da UERJ |
Texto Completo: | http://www.bdtd.uerj.br/handle/1/4585 |
Resumo: | The Brazilian Health Reform is a step ahead towards an advanced health system concept. However, despite the concrete legal progress achieved through the 1988 Constitution, expressed in reforms at the broader level, aiming to organize the assistance in a hierarchyzed services network, and the promulgation of norms for the decentralized system local management, the Brazilian Unified Health System (SUS), as other large modern organizations, experiences a lack of coordination in its operations. This work aims to discuss the possibilities and limits of the organizational changes induced by this implementation, in the very configuration of regionalized health systems from the viewpoint of international experience with health systems reforms, taking into account the most recent contributions of the organizational theories, considering the transitional context from fordism to post-fordism. From the theoretical perspective of systems, we consider the contribution of organization theories, regarding the specificity of the field of public health, to argue the effectiveness of its regulation subsystems: control and evaluation, regulation, medical audit, health Information and also the surveillance and disease control systems, within the complex configuration of political power in this sector, in Brazil. SUS, characterized by a mix of two fordist organizational patterns the National Institute of Social Security (INAMPS) and traditional Public Health systems fails to build competent organizational structures, since it reproduces traditional models in its controlling systems. These difficulties are due in part to historical determinants, which made the legal advances towards a more comprehensive health right coincide with State reforms arisen from the crisis of fordist regulation patterns, and also with worldwide deep societal transformations, like demographic and epidemiological transitions, and the high costs of medical technology. On the other hand, the availability of post-fordist organizational solutions provides patterns for new rules and ways for health systems regulation, which lead to self-regulated behaviors on the part of health care providers, considering the goals of equity and improvement of populational health. The author conclude that necessary health care reform in Brazil requires the strengthening technobureaucracy protected against political-partisan injunctions, allowing the incubation of a professional organizational culture in all government and managerial levels, fostering the competent health work, committed with SUS s purposes. |
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Kornis, George Edward Machadohttp://lattes.cnpq.br/6695262640602547Mattos, Ruben Araújo dehttp://lattes.cnpq.br/5813862906022002Dain, Sulamishttp://lattes.cnpq.br/5347631502837998Teixeira, Maria Teresa Bustamantehttp://lattes.cnpq.br/4231160378291465http://lattes.cnpq.br/4712595835650767Alves, Márcio José Martins2020-08-02T16:51:20Z2012-04-112006-05-30ALVES, Márcio José Martins. Sistema Único de Saúde: de que sistema se trata?. 2006. 208 f. Tese (Doutorado em Ciências Humanas e Saúde; Epidemiologia; Política, Planejamento e Administração em Saúde; Administra) - Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 2006.http://www.bdtd.uerj.br/handle/1/4585The Brazilian Health Reform is a step ahead towards an advanced health system concept. However, despite the concrete legal progress achieved through the 1988 Constitution, expressed in reforms at the broader level, aiming to organize the assistance in a hierarchyzed services network, and the promulgation of norms for the decentralized system local management, the Brazilian Unified Health System (SUS), as other large modern organizations, experiences a lack of coordination in its operations. This work aims to discuss the possibilities and limits of the organizational changes induced by this implementation, in the very configuration of regionalized health systems from the viewpoint of international experience with health systems reforms, taking into account the most recent contributions of the organizational theories, considering the transitional context from fordism to post-fordism. From the theoretical perspective of systems, we consider the contribution of organization theories, regarding the specificity of the field of public health, to argue the effectiveness of its regulation subsystems: control and evaluation, regulation, medical audit, health Information and also the surveillance and disease control systems, within the complex configuration of political power in this sector, in Brazil. SUS, characterized by a mix of two fordist organizational patterns the National Institute of Social Security (INAMPS) and traditional Public Health systems fails to build competent organizational structures, since it reproduces traditional models in its controlling systems. These difficulties are due in part to historical determinants, which made the legal advances towards a more comprehensive health right coincide with State reforms arisen from the crisis of fordist regulation patterns, and also with worldwide deep societal transformations, like demographic and epidemiological transitions, and the high costs of medical technology. On the other hand, the availability of post-fordist organizational solutions provides patterns for new rules and ways for health systems regulation, which lead to self-regulated behaviors on the part of health care providers, considering the goals of equity and improvement of populational health. The author conclude that necessary health care reform in Brazil requires the strengthening technobureaucracy protected against political-partisan injunctions, allowing the incubation of a professional organizational culture in all government and managerial levels, fostering the competent health work, committed with SUS s purposes.Constata-se que a reforma sanitária brasileira representa um avanço na direção de uma concepção avançada de sistema de saúde. Entretanto o SUS, com toda a materialidade das reformas ao nível macro induzidas a partir dos avanços na legislação, a implantação da regionalização e hierarquização da assistência, e dos instrumentos de gestão, assim como todas as grandes organizações modernas, padece de problemas de coordenação na operação de suas ações. Este trabalho pretende discutir as possibilidades e limites das mudanças organizacionais induzidas pela implementação do SUS na configuração dos sistemas locoregionais de saúde, à luz das experiências internacionais e das contribuições mais recentes das teorias organizacionais, no contexto da transição do fordismo à acumulação flexível. A partir do referencial da teoria dos sistemas, considera-se a contribuição das teorias organizacionais fordistas, pós-fordistas e pós-modernistas na especificidade do campo da saúde coletiva, para discutir a efetividade dos seus subsistemas cibernéticos do SUS: controle, avaliação, regulação, auditoria e vigilância em saúde, no complexo contexto da configuração do poder deste setor. Verifica-se que o SUS, constituído a partir de culturas organizacionais fordistas, do antigo INAMPS e da Saúde Pública tradicional, não tem obtido êxito em configurar estruturas organizacionais competentes, na medida em que reproduz os modelos tradicionais nos seus sistemas de controle. Esta dificuldade em parte deve-se ao momento histórico, que fez coincidir o momento dos avanços na legislação, em direção à ampliação do direito à saúde, com o momento das reestruturações dos aparelhos estatais decorrente da crise global do modo de produção fordista, e com as profundas transformações demográficas, epidemiológicas e da tecnologia da assistência médica. Por outro lado, a disponibilidade de soluções pósfordistas propicia um padrão para a conformação de novas regras e novos modos de regulação do sistema de saúde, que induzam a comportamentos auto-reguladores por parte dos prestadores de serviços de saúde, considerando as metas de equidade e de melhoria da saúde da população. Conclui-se que a necessária reforma do setor saúde demanda o fortalecimento de uma tecno-burocracia protegida contra injunções político-partidárias, que possibilite a incubação uma cultura organizacional profissional em todas as esferas de governo e níveis de gestão, que incentive um trabalho em saúde competente e moralmente comprometido com as finalidades do SUS nesse país.Submitted by Boris Flegr (boris@uerj.br) on 2020-08-02T16:51:20Z No. of bitstreams: 1 Marcio Jose M Alves - Tese.pdf: 3646169 bytes, checksum: f122d684ff020e9376217288b802528f (MD5)Made available in DSpace on 2020-08-02T16:51:20Z (GMT). No. of bitstreams: 1 Marcio Jose M Alves - Tese.pdf: 3646169 bytes, checksum: f122d684ff020e9376217288b802528f (MD5) Previous issue date: 2006-05-30application/pdfporUniversidade do Estado do Rio de JaneiroPrograma de Pós-Graduação em Saúde ColetivaUERJBRCentro Biomédico::Instituto de Medicina SocialSystems TheoryHealth systemsHealth Care ReformsPost fordismPost modernismComplexityTeoria dos SistemasSistemas de saúdeReformas do setor saúdePós-fordismoPós-modernismoTeoria da ComplexidadeCNPQ::CIENCIAS DA SAUDE::SAUDE COLETIVASistema Único de Saúde: de que sistema se trata?Unified Health System: what system is it?info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesisinfo:eu-repo/semantics/openAccessreponame:Biblioteca Digital de Teses e Dissertações da UERJinstname:Universidade do Estado do Rio de Janeiro (UERJ)instacron:UERJORIGINALMarcio Jose M Alves - Tese.pdfapplication/pdf3646169http://www.bdtd.uerj.br/bitstream/1/4585/1/Marcio+Jose+M+Alves+-+Tese.pdff122d684ff020e9376217288b802528fMD511/45852024-02-26 20:20:58.23oai:www.bdtd.uerj.br:1/4585Biblioteca Digital de Teses e Dissertaçõeshttp://www.bdtd.uerj.br/PUBhttps://www.bdtd.uerj.br:8443/oai/requestbdtd.suporte@uerj.bropendoar:29032024-02-26T23:20:58Biblioteca Digital de Teses e Dissertações da UERJ - Universidade do Estado do Rio de Janeiro (UERJ)false |
dc.title.por.fl_str_mv |
Sistema Único de Saúde: de que sistema se trata? |
dc.title.alternative.eng.fl_str_mv |
Unified Health System: what system is it? |
title |
Sistema Único de Saúde: de que sistema se trata? |
spellingShingle |
Sistema Único de Saúde: de que sistema se trata? Alves, Márcio José Martins Systems Theory Health systems Health Care Reforms Post fordism Post modernism Complexity Teoria dos Sistemas Sistemas de saúde Reformas do setor saúde Pós-fordismo Pós-modernismo Teoria da Complexidade CNPQ::CIENCIAS DA SAUDE::SAUDE COLETIVA |
title_short |
Sistema Único de Saúde: de que sistema se trata? |
title_full |
Sistema Único de Saúde: de que sistema se trata? |
title_fullStr |
Sistema Único de Saúde: de que sistema se trata? |
title_full_unstemmed |
Sistema Único de Saúde: de que sistema se trata? |
title_sort |
Sistema Único de Saúde: de que sistema se trata? |
author |
Alves, Márcio José Martins |
author_facet |
Alves, Márcio José Martins |
author_role |
author |
dc.contributor.advisor1.fl_str_mv |
Kornis, George Edward Machado |
dc.contributor.advisor1Lattes.fl_str_mv |
http://lattes.cnpq.br/6695262640602547 |
dc.contributor.referee1.fl_str_mv |
Mattos, Ruben Araújo de |
dc.contributor.referee1Lattes.fl_str_mv |
http://lattes.cnpq.br/5813862906022002 |
dc.contributor.referee2.fl_str_mv |
Dain, Sulamis |
dc.contributor.referee2Lattes.fl_str_mv |
http://lattes.cnpq.br/5347631502837998 |
dc.contributor.referee3.fl_str_mv |
Teixeira, Maria Teresa Bustamante |
dc.contributor.referee3Lattes.fl_str_mv |
http://lattes.cnpq.br/4231160378291465 |
dc.contributor.authorLattes.fl_str_mv |
http://lattes.cnpq.br/4712595835650767 |
dc.contributor.author.fl_str_mv |
Alves, Márcio José Martins |
contributor_str_mv |
Kornis, George Edward Machado Mattos, Ruben Araújo de Dain, Sulamis Teixeira, Maria Teresa Bustamante |
dc.subject.eng.fl_str_mv |
Systems Theory Health systems Health Care Reforms Post fordism Post modernism Complexity |
topic |
Systems Theory Health systems Health Care Reforms Post fordism Post modernism Complexity Teoria dos Sistemas Sistemas de saúde Reformas do setor saúde Pós-fordismo Pós-modernismo Teoria da Complexidade CNPQ::CIENCIAS DA SAUDE::SAUDE COLETIVA |
dc.subject.por.fl_str_mv |
Teoria dos Sistemas Sistemas de saúde Reformas do setor saúde Pós-fordismo Pós-modernismo Teoria da Complexidade |
dc.subject.cnpq.fl_str_mv |
CNPQ::CIENCIAS DA SAUDE::SAUDE COLETIVA |
description |
The Brazilian Health Reform is a step ahead towards an advanced health system concept. However, despite the concrete legal progress achieved through the 1988 Constitution, expressed in reforms at the broader level, aiming to organize the assistance in a hierarchyzed services network, and the promulgation of norms for the decentralized system local management, the Brazilian Unified Health System (SUS), as other large modern organizations, experiences a lack of coordination in its operations. This work aims to discuss the possibilities and limits of the organizational changes induced by this implementation, in the very configuration of regionalized health systems from the viewpoint of international experience with health systems reforms, taking into account the most recent contributions of the organizational theories, considering the transitional context from fordism to post-fordism. From the theoretical perspective of systems, we consider the contribution of organization theories, regarding the specificity of the field of public health, to argue the effectiveness of its regulation subsystems: control and evaluation, regulation, medical audit, health Information and also the surveillance and disease control systems, within the complex configuration of political power in this sector, in Brazil. SUS, characterized by a mix of two fordist organizational patterns the National Institute of Social Security (INAMPS) and traditional Public Health systems fails to build competent organizational structures, since it reproduces traditional models in its controlling systems. These difficulties are due in part to historical determinants, which made the legal advances towards a more comprehensive health right coincide with State reforms arisen from the crisis of fordist regulation patterns, and also with worldwide deep societal transformations, like demographic and epidemiological transitions, and the high costs of medical technology. On the other hand, the availability of post-fordist organizational solutions provides patterns for new rules and ways for health systems regulation, which lead to self-regulated behaviors on the part of health care providers, considering the goals of equity and improvement of populational health. The author conclude that necessary health care reform in Brazil requires the strengthening technobureaucracy protected against political-partisan injunctions, allowing the incubation of a professional organizational culture in all government and managerial levels, fostering the competent health work, committed with SUS s purposes. |
publishDate |
2006 |
dc.date.issued.fl_str_mv |
2006-05-30 |
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2012-04-11 |
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2020-08-02T16:51:20Z |
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publishedVersion |
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ALVES, Márcio José Martins. Sistema Único de Saúde: de que sistema se trata?. 2006. 208 f. Tese (Doutorado em Ciências Humanas e Saúde; Epidemiologia; Política, Planejamento e Administração em Saúde; Administra) - Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 2006. |
dc.identifier.uri.fl_str_mv |
http://www.bdtd.uerj.br/handle/1/4585 |
identifier_str_mv |
ALVES, Márcio José Martins. Sistema Único de Saúde: de que sistema se trata?. 2006. 208 f. Tese (Doutorado em Ciências Humanas e Saúde; Epidemiologia; Política, Planejamento e Administração em Saúde; Administra) - Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 2006. |
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