Turino Fabiana, Fernandes Lorena Estevam Martins, Soares Gabriella Barreto, Castro Gabriella Bigossi de, Salles Shayene Machado, Zaganelli Juliana Costa, Siqueira Carlos Eduardo Gomes, Bussinger Elda Coelho de Azevedo, Sodré Francis
Universidade Federal do Espírito Santo, Vitória, Brasil.
Faculdade de Direito de Vitória, Vitória, Brasil.
Cad Saude Publica. 2022 Aug 26;38Suppl 2(Suppl 2):e00350020. doi: 10.1590/0102-311X00350020. eCollection 2022.
This article analyzed the activity of Social Health Organizations (OSS) in the Brazilian Unified National Health System (SUS) and the use of management contracts and contract addenda as instruments of privatization. The article aimed to understand the processes that legitimize privatization, based on quantification of the amounts transferred through management contracts and contract addenda to organizations that signed contracts with the Rio de Janeiro Municipal Health Department, Rio de Janeiro, Brazil, from 2009 to 2018. A descriptive, exploratory, mixed-methods study was developed to analyze the amounts transferred to the OSS. The study used secondary public data available on the Health Department's websites and other official documents. A total of 268 documents were identified, 61 of which were contracts and 207 addenda, related to 15 institutions. The funds transferred to these organizations totaled BRL 15.94 billion (USD 2.9 billion). The OSS that received the most public funds was IABAS (Institute of Primary and Advanced Health Care), with a total of BRL 4.021 billion (USD 731 million). In 2014, Rio de Janeiro's total health budget was approximately BRL 4 billion (USD 727 million), of which BRL 2.5 billion (USD 455 million) was transferred to OSS, representing 62% of the municipal health budget. The data show that management contracts and contract addenda serve as instruments for privatization of the SUS. This privatization does not employ the conventional model but a functional and fluctuating one.
本文分析了巴西统一国家卫生系统（SUS）中社会卫生组织（OSS）的活动，以及管理合同和合同附录作为私有化工具的使用情况。本文旨在通过量化2009年至2018年期间通过管理合同和合同附录转移给与巴西里约热内卢市卫生局签订合同的组织的金额，来了解使私有化合法化的过程。开展了一项描述性、探索性的混合方法研究，以分析转移给OSS的金额。该研究使用了卫生局网站上公开的二手数据和其他官方文件。共识别出268份文件，其中61份是合同，207份是附录，涉及15个机构。转移给这些组织的资金总计159.4亿雷亚尔（29亿美元）。获得公共资金最多的OSS是IABAS（初级和高级医疗保健研究所），总计40.21亿雷亚尔（7.31亿美元）。2014年，里约热内卢的卫生总预算约为40亿雷亚尔（7.27亿美元），其中25亿雷亚尔（4.55亿美元）转移给了OSS，占市政卫生预算的62%。数据表明，管理合同和合同附录是SUS私有化的工具。这种私有化并非采用传统模式，而是一种功能性的、波动的模式。
