Machado Cristiani Vieira, Lima Luciana Dias de, Baptista Tatiana Wargas de Faria
Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
Cad Saude Publica. 2017 Oct 2;33Suppl 2(Suppl 2):e00129616. doi: 10.1590/0102-311X00129616.
This article analyzes the trajectory of national health policy in Brazil from 1990 to 2016 and explores the policy's contradictions and conditioning factors during the same period. Continuities and changes were seen in the policy's context, process, and content in five distinct moments. The analysis of the policy's conditioning factors showed that the Constitutional framework, institutional arrangements, and action by health sector stakeholders were central to the expansion of public programs and services, providing the material foundations and expanding the basis of support for the Brazilian Unified National Health System at the health sector level. However, historical and structural limitations, institutional legacies, and the dispute between projects for the sector have influenced national health policy. Interaction between these conditioning factors explains the policy's contradictions during the period, for example with regard to health's position in the national development model and social security system and the financing and public-private relations in health. Expansion of public services occurred simultaneously with the strengthening of private segments. Dynamic health markets that compete for resources from government and families, limit the possibility of consolidating a universal health system, and reiterate social stratification and inequalities in health.
本文分析了1990年至2016年巴西国家卫生政策的轨迹，并探讨了同期该政策的矛盾和制约因素。在五个不同阶段，政策的背景、过程和内容出现了连续性和变化。对政策制约因素的分析表明，宪法框架、制度安排以及卫生部门利益相关者的行动对于公共项目和服务的扩展至关重要，在卫生部门层面为巴西统一国家卫生系统提供了物质基础并扩大了支持基础。然而，历史和结构限制、制度遗产以及该部门各项目之间的争议影响了国家卫生政策。这些制约因素之间的相互作用解释了该时期政策的矛盾之处，例如在卫生在国家发展模式和社会保障体系中的地位以及卫生领域的融资和公私关系方面。公共服务的扩展与私营部门的强化同时发生。充满活力的卫生市场争夺政府和家庭的资源，限制了巩固全民卫生系统的可能性，并再次凸显了社会分层和卫生不平等现象。
