Andrade Laíse Rezende de, Pinto Isabela Cardoso de Matos
Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil.
Cad Saude Publica. 2022 Feb 11;38(2):e00018621. doi: 10.1590/0102-311X00018621. eCollection 2022.
The process of building Brazil´s Unified Health System has always been a space of dispute between the political forces that defend greater private sector participation in patient care and administration of services and those who defend strengthening public administration. In the context of underfinancing of the Brazilian Unified National Health System (SUS), associated with the restrictions imposed by the so-called Fiscal Responsibility Law, new management models have been adopted in hospital administration, including public-private partnerships (PPPs). Considering the relevance of investigating decision-making processes pertaining to the adoption of these models by State Health Departments, this study aims to analyze the decision-making processes and incorporation of this hospital administration model in the State of Bahia, Brazil, the first administrative concession in Brazil´s health sector. This is a case study in which the theoretical reference was Social Game Theory elaborated by Carlos Matus, linked to the Public Policy Cycle analytical model. The data were produced with document research and semi-structured interviews with key informants who participated in the pre-decision and decision-making stages of the PPP model. The article presents the political game involved in the choice of this alternative among other hospital administration models, besides debating the models´ advantages and disadvantages according to the key actors and concludes that determinants (not only financial, but also political and ideological) marked the decision-making process for the PPP model in Bahia, in which the driving factor and source of consultancy was the International Finance Corporation, an arm of the World Bank.
构建巴西统一卫生系统的过程一直是一个充满争议的领域，一方是主张扩大私营部门参与患者护理和服务管理的政治力量，另一方是主张加强公共管理的力量。在巴西统一国家卫生系统（SUS）资金不足的背景下，再加上所谓的《财政责任法》所施加的限制，医院管理中采用了新的管理模式，包括公私合营（PPP）。鉴于调查州卫生部门采用这些模式的决策过程具有重要意义，本研究旨在分析巴西巴伊亚州采用这种医院管理模式的决策过程及情况，巴伊亚州是巴西卫生部门首个行政特许权授予案例。这是一项案例研究，其理论参考是卡洛斯·马图斯阐述的社会博弈论，该理论与公共政策周期分析模型相关。数据通过文献研究以及对参与公私合营模式决策前和决策阶段的关键信息提供者进行半结构化访谈得出。本文介绍了在其他医院管理模式中选择这一模式所涉及的政治博弈，同时根据关键行为体对该模式的优缺点进行了辩论，并得出结论：决定性因素（不仅是财务方面，还有政治和意识形态方面）影响了巴伊亚州公私合营模式的决策过程，其中推动因素和咨询来源是世界银行下属的国际金融公司。
