Consórcios públicos de saúde no Estado de São Pauloeficiência, qualidade e sustentabilidade na cooperação intermunicipal

Resumo

This study analyzes intermunicipal public health consortia as instruments of intergovernmental governance and regionalization of public health policies in Brazil, focusing on eleven mediumand high-complexity consortia in the State of São Paulo. It seeks to understand how these institutional arrangements contribute to administrative efficiency, expanded access to services, and the financial sustainability of the Unified Health System (SUS). Methodologically, the research adopts a qualitative and descriptive approach based on documentary analysis of oversight reports, financial statements, and institutional acts from 2023, complemented by a literature review on shared management and federative cooperation. The study also examined cost-sharing contracts and the criteria used to distribute expenses among member municipalities, identifying that models combining population, demand, and service utilization tend to promote financial stability and reduce default, reinforcing the importance of transparent financial arrangements for effective intergovernmental governance. Based on four analytical dimensions (efficiency, quality, financial sustainability, and governance), a typology was developed classifying the consortia as structured, intermediate, or fragile according to their institutional maturity. The findings reveal significant differences: structured consortia display consolidated management and active governance; intermediate ones still face challenges in planning and control; and fragile consortia struggle with chronic default, fiscal imbalance, and institutional vulnerability. The study concludes that the sustainability of public health consortia depends on the articulation between legal security, fiscal responsibility, and administrative capacity, supported by continuous planning and cooperative practices. Cost-sharing models and the level of institutional maturity are key determinants of financial balance and of strengthening health regionalization within the SUS, offering relevant insights for improving public policies and municipal governance.

Ficha do documento

Tipo

Dissertação

Ano

2025

Instituição

Fundação Getulio Vargas

Fonte

Repositório da FGV

Idioma

Português

Acesso

Acesso aberto

Identificador

oai:repositorio.fgv.br:10438/38051

Temas

Políticas PúblicasFinanças PúblicasAdministração PúblicaGovernançaSaúdeMeio AmbienteGestão Municipal

Palavras-chave

ConsórciosGovernança públicaAdministração municipalCooperação intergovernamentalSaúde públicaPublic health consortiaIntergovernmental governanceIntermunicipal cooperationIntergovernmental arrangementsSocial and territorial managementAdministração públicaSaúde pública - São Paulo (Estado)