Sestelo José Antonio de Freitas, Tavares Leandro Reis, Silva Milton Santos Martins da
Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil.
Tribunal Regional do Trabalho da 5ª Região, Salvador, Brasil.
Cad Saude Publica. 2022 Aug 26;38Suppl 2(Suppl 2):e00075621. doi: 10.1590/0102-311X00075621. eCollection 2022.
The article aims to describe the characteristics of financialization in a set of ten companies and economic groups operating health plans and insurance in Brazil from 2008 to 2016, selected according to their turnover and the size of their client portfolio. The financial/accounting and net worth dimensions were analyzed according to the balance sheets and cash flows, compared to microeconomic indicators of financialization and the records of changes in the shareholding structure filed with commercial boards. The authors analyzed the companies' policy positions based on primary data from semi-structured interviews with qualified representatives and the analysis of shareholder reports and news from the specialized media. In short, financial dominance is expressed in the health plans studied here, but their characterization does not follow a universally reproducible and homogeneous pattern, and empirical research should play a key role in further investigating the phenomenon. Since health and healthcare are defined constitutionally as publicly relevant goods that require support by stable and equitable policies in the distribution of available resources, and given the oligopolistic and concentrating trend in the inherent resources in the process of financialization (in opposition to this guideline) and the strategic place occupied by these companies, the prospects for the system as a whole tend to evolve towards an increase in total health expenditures, with greater concentration of healthcare resources and circulation of resources in the financial accumulation sphere.
本文旨在描述2008年至2016年期间巴西十家经营健康计划和保险的公司及经济集团的金融化特征,这些公司和集团是根据其营业额和客户组合规模挑选出来的。根据资产负债表和现金流量分析了金融/会计和净资产维度,并与金融化的微观经济指标以及提交给商业委员会的股权结构变化记录进行了比较。作者根据对合格代表进行的半结构化访谈的原始数据以及对股东报告和专业媒体新闻的分析,分析了这些公司的政策立场。简而言之,金融主导地位在本文所研究的健康计划中有所体现,但其特征并非遵循普遍可复制且同质化的模式,实证研究应在进一步调查这一现象中发挥关键作用。鉴于健康和医疗保健在宪法上被定义为具有公共相关性的商品,需要稳定且公平的政策在可用资源分配中提供支持,同时考虑到金融化过程中固有资源的寡头垄断和集中趋势(与这一指导方针相悖)以及这些公司所占据的战略地位,整个体系的前景倾向于朝着总医疗支出增加的方向发展,医疗资源更加集中,资源在金融积累领域循环。