Políticas de saúde no pós-constituinte: um estudo da política implementada a partir da produção normativa dos poderes executivo e legislativo no Brasil

• Autor(a) principal: Baptista, Tatiana Wargas de Faria
• Data de Publicação: 2003
• 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/1/19378
• topic: Política de saúde; Processo decisório; Implementação de políticas; Poder executivo; Poder legislativo; Health policy; Decision-making process; Implementation of policy; Executive branch; Legislative branch; CIENCIAS DA SAUDE::SAUDE COLETIVA

The implementation of health policy in Brazil during the 1990s and the beginning of this decade (2000) has led to many changes; while advances have been made towards the construction of the Unified System (SUS, in the Portuguese acronym), these changes have also raised challenges and dilemmas to the implementation of the SUS. This study focuses on the implementation of Brazilian health policy since the Health Act of 1990 (Law 8080), regulating the SUS, until 2002; it analyses policies approved by Congress (Legislative Branch) and regulations issued by the Ministry of Health (Executive Branch). The central objective of the study is understand the underlying logic of health policy in Brazil, how priorities are established and how demands are processed, and to identify patterns of relationship between the Executive and Legislative Branches and the particular way each branch of government operates regarding health policy. The study shows that in the process of implementing the SUS, the Executive Branch of the federal government (the Ministry of Health) continues to induce action on the part of other spheres of government and to concentrate power, that is also the case in the Ministry’s relationship to the Legislative Branch (Congress). This concentration of decision-making power is maintained on the basis of a tacit agreement between states and municipalities and the Legislative Brach, which benefit from this relationship by maintaining old practices of political and institutional patronage within the Brazilian State. Strategies to expand access to health care and to regulate the private health care market were established without laying out the State’s priorities and in a decision- making processes that encouraged excessive fragmentation of policy, benefiting the groups with the greatest political and institutional power. In the federal sphere, Executive authorities with different political perspectives coexist, mediating the interests of the health complex: the Reformist Executive, oriented to the interests of social movements; the traditional Health Executive, whose constituency is the institutional bureaucracy of the old Ministry of Health (pre-SUS) and INAMPS (the former public health service for social security contributors), is more or less sensitive to health demands; the Executive Presidency expresses current government policy and uses health as an important field in which to filter social relations, with a view to political power. This study reaffirms the importance of a new pact between the State and society in Brazil to define a political project that serves the public interest and to defend a policy for public health.