Federalismo e políticas de saúde no Brasil: características institucionais e desigualdades regionais

Abstract

This article analyses the main characteristics of federalism in Brazil and its institutional relations with health policy. It discusses federalism from a classical perspective highlighting the essentially centralized nature of Brazil's system and the prevalence of decentralizing health policies underpinned by the principles enshrined by the 1988 Constitution.We used primary data obtained from an electronic questionnaire responded by secretaries of health sitting on the governing bodies of the country's health region and secondary data Ministry of Health databases covering the current health regions. The findings show that significant progress has been made in the implementation of regional governing bodies, yet without any significant impact on the reduction of deep regional inequalities in primary and hospital care. It concludes by suggesting that the persistence of inequalities is down to weak central coordination capacity and an inappropriate trade-off between a centralized federal system and competition between entities, thus undermining cooperative regionalization of the public health system as envisaged by the 1988 Constitution.

Delivering maternal and childcare at primary healthcare level: The role of PMAQ as a pay for performance strategy in Brazil

“…David et al [ 50 ] and Santos et al [ 51 ] also reported better performance at primary healthcare in the poorest municipalities. Worse performance at primary healthcare in the richest municipalities may be associated with higher private health insurance coverage, supply of inpatient and outpatient facilities (secondary, tertiary and quaternary care), and lower primary healthcare coverage [ 52 – 54 ].…”

Enfermeiros (as) gestores (as) no Sistema Único de Saúde: perfil e perspectivas com ênfase no Ciclo de Gestão 2017-2020

“…Thus, it is evident that nursing, among the various health professions, has assumed positions of direction and management, which requires from the nurse leadership skills such as flexibility, ability to discern the needs of the people supervised, and mainly the motivation of employees, making the most of their skills without exploiting them [17][18][19] .…”

Os desafios atuais da luta pelo direito universal à saúde no Brasil

“…On the other hand, the persistence of a shortage of health professionals 11 , and regional disparities in the quality of care persisted, mainly revealing the influence of socioeconomic factors 12 , as shown by the comparison of the average income of the wealthiest segment of the population with that of the poorest segment: the wealthiest 20% have an income 17 times higher than the income of the poorest 20% 13 .…”