Postgraduate Program in Public Health, Center for Health Sciences, Federal University of Espirito Santo, Vitoria, Brazil.
Institute of Population Health Sciences, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
Int J Health Serv. 2021 Jan;51(1):90-100. doi: 10.1177/0020731420961286. Epub 2020 Oct 6.
The Brazilian state apparatus was reformed throughout the 1990s, influenced by New Public Management (NPM). NPM was embodied in the health care sector by the creation of Social Health Organizations ( or OSS), private non-profit entities to provide welfare services. We performed a systematic review of the literature outlining the origins and role of OSS in Brazil. Our selected articles (peer-reviewed) cover the origins/performance of OSS and their services provision between 1998 and 2018, in English or Portuguese. Databases used were Lilacs, Bireme, Medline, Pubmed, and SciELO. We identified 4,732 articles applying a pre-defined set of descriptors, from which we selected 49 for analysis. The main findings reveal that NPM is the central theme of most articles about OSS in Brazil (n = 26). There is evidence corroborating our hypothesis that transferring management of public health care services to private non-profit organizations is a softer version of privatization as, although financing is kept public, the rationale and ethos of OSS services institutionally and operationally mimic the private sector. The practical consequence is that attainment of health care in Brazil ends up being neither fully commodified (based on ability to pay) nor fulfilled as a citizen's right following its national constitution.
巴西国家机构在整个 1990 年代进行了改革，受到了新公共管理（NPM）的影响。NPM 通过创建社会卫生组织（OSS）在医疗保健部门得到体现，OSS 是提供福利服务的私营非营利实体。我们对文献进行了系统回顾，概述了 OSS 在巴西的起源和作用。我们选择的文章（同行评议）涵盖了 OSS 的起源/绩效及其在 1998 年至 2018 年之间提供的服务，语言为英语或葡萄牙语。使用的数据库有 Lilacs、Bireme、Medline、Pubmed 和 SciELO。我们应用预定义的描述符集确定了 4732 篇文章，并从中选择了 49 篇进行分析。主要发现表明，NPM 是巴西大多数关于 OSS 文章的核心主题（n=26）。有证据支持我们的假设，即将公共医疗保健服务的管理移交给私营非营利组织是私有化的一种较软形式，因为尽管融资仍然是公共的，但 OSS 服务在制度和运营上的理念和精神模仿了私营部门。实际后果是，巴西的医疗保健服务既没有完全商品化（基于支付能力），也没有按照其国家宪法实现作为公民权利。
