Costa Nilson do Rosário
Departamento de Ciências Sociais, Escola Nacional de Saúde Pública, Fiocruz. Leopoldo Bulhões 1480, Manguinhos. 21041-210 Rio de Janeiro RJ Brasil.
Cien Saude Colet. 2017 Apr;22(4):1065-1074. doi: 10.1590/1413-81232017224.28192016.
This paper presents the arguments in favor of government intervention in financing and regulation of health in Brazil. It describes the organizational arrangement of the Brazilian health system, for the purpose of reflection on the austerity agenda proposed for the country. Based on the literature in health economics, it discusses the hypothesis that the health sector in Brazil functions under the dominance of the private sector. The categories employed for analysis are those of the national health spending figures. An international comparison of indicators of health expenses shows that Brazilian public spending is a low proportion of total spending on Brazilian health. Expenditure on individuals' health by out-of-pocket payments is high, and this works against equitability. The private health services sector plays a crucial role in provision, and financing. Contrary to the belief put forward by the austerity agenda, public expenditure cannot be constrained because the government has failed in adequate provision of services to the poor. This paper argues that, since the Constitution did not veto activity by the private sector segment of the market, those interests that have the greatest capacity to vocalize have been successful in imposing their preferences in the configuration of the sector.
本文阐述了支持巴西政府对医疗卫生融资和监管进行干预的观点。它描述了巴西卫生系统的组织架构，以便对该国提出的紧缩议程进行反思。基于卫生经济学文献，它讨论了巴西卫生部门在私营部门主导下运作的假设。用于分析的类别是国家卫生支出数据的类别。卫生费用指标的国际比较表明，巴西公共支出在巴西卫生总支出中所占比例较低。自付费用用于个人卫生的支出较高，这不利于公平性。私营卫生服务部门在提供和融资方面发挥着关键作用。与紧缩议程提出的观点相反，公共支出不能受到限制，因为政府未能为穷人提供足够的服务。本文认为，由于宪法没有否决市场私营部门的活动，那些最有能力发声的利益集团成功地在该部门的配置中强加了他们的偏好。
