0175/2018 - Federalismo e políticas de saúde no Brasil: Características institucionais e desigualdades regionais. Federalism and health policy in Brazil: Institutional features and regional inequalities.
Este artigo analisa as características do federalismo no Brasil e suas relações institucionais com as políticas de saúde. Em termos conceituais, articula elementos teóricos tradicionais com a tradição predominante no país acerca do caráter centralizador do federalismo e descentralizador das políticas decorrentes da Constituição de 1998. As bases empíricas incluem fontes primárias (pesquisa censitária com os secretários municipais de saúde participantes de colegiados estaduais) e secundárias (bases administrativas do Ministério da Saúde consolidadas nas regiões de saúde existentes). O artigo demonstra a implantação avançada dos colegiados regionais de gestão, porém sem repercussão direta na redução das grandes desigualdades regionais observadas na atenção primária e hospitalar. Conclui atribuindo a persistência destas disparidades à baixa capacidade de coordenação central e a um trade-off inadequado entre a centralização federativa na União e os componentes competitivos entre entes subnacionais. Como resultado, as dimensões cooperativas esperadas pelo desenho constitucionais são comprometidas para além da influência dos fatores socioeconômicos tradicionais.
Palavras-chave:
Federalismo; Desigualdades Regionais; Sistema Único de Saúde
Abstract:
This article analyses major characteristics of federalism in Brazil and its institutional relations with health policies. Conceptually speaking it combines traditional theoretical issues to main traditions in Brazil as to its centralized pattern of federalism and decentralized social policies established in the Constitution of 1988. Empirical basis includes primary (inquiry with all health administrators with a seat in state level management councils), secondary sources (Health Ministry administrative databases aggregated in regional councils). The article reveals advanced implementation of regional management councils although without big impacts in reducing great regional inequalities in primary and hospital care. It concludes naming these inequalities to low capacity of central coordination and an inadequate trade-off in federative Union centralization and competitive issues in subnational levels. All of these fails the cooperative expectations according to constitutional design besides traditional socioeconomics intervening variables.
Keywords:
Federalism; Regional Inequalities; Unified Health System
Federalism and health policy in Brazil: Institutional features and regional inequalities.
Resumo (abstract):
This article analyses major characteristics of federalism in Brazil and its institutional relations with health policies. Conceptually speaking it combines traditional theoretical issues to main traditions in Brazil as to its centralized pattern of federalism and decentralized social policies established in the Constitution of 1988. Empirical basis includes primary (inquiry with all health administrators with a seat in state level management councils), secondary sources (Health Ministry administrative databases aggregated in regional councils). The article reveals advanced implementation of regional management councils although without big impacts in reducing great regional inequalities in primary and hospital care. It concludes naming these inequalities to low capacity of central coordination and an inadequate trade-off in federative Union centralization and competitive issues in subnational levels. All of these fails the cooperative expectations according to constitutional design besides traditional socioeconomics intervening variables.
Palavras-chave (keywords):
Federalism; Regional Inequalities; Unified Health System
Ribeiro, J.M., Rasga, Marcelo, Ouverney, A.M, Pinto, L. F., Silva, C. M. F. P. Federalismo e políticas de saúde no Brasil: Características institucionais e desigualdades regionais.. Cien Saude Colet [periódico na internet] (2018/Abr). [Citado em 08/11/2024].
Está disponível em: http://cienciaesaudecoletiva.com.br/artigos/federalismo-e-politicas-de-saude-no-brasil-caracteristicas-institucionais-e-desigualdades-regionais/16708?id=16708
