Contreiras Henrique, Matta Gustavo Corrêa
Cad Saude Publica. 2015 Feb;31(2):285-97. doi: 10.1590/0102-311x00015914.
The article describes and discusses privatization of the municipal health system in São Paulo, Brazil, from an administrative and political perspective. The methodology consisted of a literature review and analysis of legislation and public documents. The study showed that although legislation governing the so-called "Social Organizations" (OS) in Brazil dates to the year 2006, half of the administrative privatization is still regulated by a previous provisional instrument in the form of an "agreement" ("convênio" in Portuguese). In 2011, 61% of services were administered by private organizations, which received 44% of the health budget in 2012. The twenty participating organizations include five of the ten largest health care companies in Brazil. Inspection agencies have detected flaws in the management contracts, but the "agreements" (convênios) are subject to less rigorous control and have proven invisible to inspection. Finally, the legal framework is unstable. The study uses the experience in São Paulo as the basis for discussing the political versus technical nature of private management in the Brazilian Unified National Health System (SUS).
本文从行政和政治角度描述并讨论了巴西圣保罗市卫生系统的私有化。研究方法包括文献综述以及对立法和公共文件的分析。研究表明，尽管巴西规范所谓“社会组织”（OS）的立法可追溯到2006年，但行政私有化的一半仍由先前以“协议”（葡萄牙语为“convênio”）形式存在的临时文书进行监管。2011年，61%的服务由私人组织管理，这些组织在2012年获得了44%的卫生预算。参与的20个组织包括巴西十大医疗保健公司中的五家。检查机构已发现管理合同存在缺陷，但“协议”（convênios）受到的监管较宽松，且已证明检查难以察觉。最后，法律框架不稳定。该研究以圣保罗的经验为基础，讨论巴西统一国家卫生系统（SUS）中私人管理的政治性质与技术性质。
