Inovações na gestão do sistema de saúde brasileirodesafios e oportunidades da interface público e privada a partir da atenção primária

Resumo

The strategic articulation between the public and private sectors in health systems is a challenge for advancing universal health coverage. Relevant contributions on the subject have highlighted the harmful effects, but little attention has been given to the creation of regulatory and coordination mechanisms between the two sectors to increase efficiency, mitigate inequities and expand care coverage. The Brazilian Unified Health System (SUS) is composed of a publicprivate mix, with financing, sustainability and little synergy problems. The recognized implementation of Primary Health Care by the SUS and the recent look at better models of care for Supplementary Health caused the migration of managers between the systems and opened new conformations. The study seeks to answer whether this new situation has brought SUS experiences that could be incorporated into Supplementary Health and whether innovations developed in Supplementary Health could be examples to respond to SUS problems, in addition to evaluating opportunities for advancement in coordinated actions. A qualitative method was used through interviews with 13 managers with the criterion of having performed management in the SUS and in Supplementary Health. For the analysis, it was necessary to categorize the experiences and aspects raised through an analytical matrix based on the functions and objectives of the WHO health system. A total of 296 aspects and experiences were raised, categorized as positives or weaknesses of each subsystem. It was found that characteristics identified as weaknesses of Supplementary Health are, to a large extent, positive aspects and experiences of the SUS, especially in governance, institutional culture and aspects of care and network coordination. Of these, there was great relevance in governance with insufficient regulation attributed mainly to the National Supplementary Health Agency (ANS) and lack of alignment of its model with the ministry of health. In the same way that there is a similarity between the weaknesses of the SUS and the positive aspects and experiences of Supplementary Health, mainly in terms of flexibility and innovations in financing and payment; in management and governance; in the allocation of resources and in experiences of digital expansion of access and coordination of care. Experiences and opportunities for coordinated actions between public systems and supplementary health were raised through the expansion of state funding and innovations in payment methods, improvement in governance processes, joint actions of resource allocation including training centers and also through alignments in coordination of care and assistance network. They bring as challenges structural aspects such as the difficulty of interoperability, in addition to cultural, political and ideological aspects.

Ficha do documento

Tipo

Dissertação

Ano

2022

Instituição

Fundação Getulio Vargas

Fonte

Repositório da FGV

Idioma

Português

Acesso

Acesso aberto

Identificador

oai:repositorio.fgv.br:10438/32772

Temas

PPPAdministração PúblicaTecnologiaGovernançaSaúde

Palavras-chave

Health policyPrimary health carePublic-private mixDuplicated coveragePolíticas de saúdeAtenção primária à saúdeMix público-privadoCobertura duplicadaSaúdeAdministração públicaAdministração de empresasPolítica de saúde - BrasilCuidados Primários de SaúdeParceria público-privadaSistema Único de Saúde (Brasil)Saúde suplementar