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Doctoral Thesis
DOI
10.11606/T.6.2018.tde-01022018-165536
Document
Author
Full name
Ana Adelaide Martins
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 1995
Supervisor
Committee
Alvarenga, Augusta Thereza de (President)
Buralli, Keiko Ogura
Carvalheiro, Jose da Rocha
Oliveira, Francisco Maria Cavalcante de
Viana, Ana Luiza D Avila
Title in Portuguese
Relações estado-sociedade e políticas de saúde: considerações sobre os conceitos de esfera pública, fundo público e padrão de financiamento das instituições de saúde, contexto sócio-histórico de sua emergência e relevância no estudo da reforma sanitária brasileira
Keywords in Portuguese
Políticas de Saúde
Relações Estado-sociedade
Abstract in Portuguese
A presente Tese oferece uma proposta teórico-metodológica para o estudo da Reforma Sanitária Brasileira e seus desdobramentos posteriores, baseada num esquema conceitual de onde derivam três categorias de análise - a de Esfera Pública, a de Fundo Público e a de Padrão de Financiamento Público - referidas aos determinantes sociais, econômicos e políticos que, interativamente, afetam as políticas sociais. Tem origem na constatação de que a VIII Conferência Nacional de Saúde propõe, e a Constituição de 1988 consagra, um conceito eminentemente político de Saúde, pelo qual todas as ações de Saúde são consideradas "públicas", por sua relevância social e sua participação no interesse geral, regidas por uma normatividade socialmente definida e sujeitas ao controle social institucionalizado. Desse modo, tornando a Saúde Pública o âmbito interinstitucional, multidisciplinar e popular das discussões e decisões sobre os processos saúde/doença da população - o que significa a definição de um mais amplo espaço para a Saúde Pública no interior da Esfera Pública. A aceitação generalizada das propostas da Reforma Sanitária, no período pré-Constituinte e na Constituinte, liga-se ao contexto da transição para a democracia, quando era reconhecida a falência do Padrão de Financiamento das políticas sociais adotado no regime militar, abrindo-se então espaço para proposições que visavam a um Padrão de Financiamento mais próximo do adotado na social-democracia. Entretanto, o redirecionamento do Fundo Público, pressuposto principal de viabilidade das atividades sociais e, principalmente, das mudanças constitucionais aprovadas, tem encontrado resistências e apresentado recuos, que não apenas recuperam os mecanismos viciados e distorcidos de financiamento, como têm desfigurado o modelo de Sistema único de Saúde proposto na Reforma Sanitária, tornando-o numa espécie de caricatura perversa.
Title in English
State-society relations and health policies: considerations on the concepts of public sphere, public fund and health institutions financing standard, socio-historical context of its emergence and relevance in the study of the Brazilian sanitary reform
Keywords in English
Health Policies
State-society Relations
Abstract in English
The present Thesis offers a theoretical-methodological proposition for the study of the Brazilian Health Care Reform and its later developments. It is based upon a conceptual scheme from which three categories of analyses derive - that of the Public Sphere of Ation, that of Public Fund and that of Public Financing Pattern- referred to the social, economic ando political determinants, which interactively affect the social politics. It comes from the verification that the National Health Conference proposes, and the 1988 Constitution establishes, an eminently political concept of Public Health. By this political concept all health actions are considered "public", in way of their social relevance and their participation in the general interest. And so, they must be ruled by a socially defined "normativeness", and subject to the institutionalized social control. So turning Public Health into the interinstitucional, multidiscipline and popular ambit of discussions and decisions about health/illness pqpulations processes. And it means the definition of a wider space for Public Health into Public Sphere. The generalized acceptance of the Health Care Reform propositions in the period prior of the Constituent Assembly performance, and in the working period of the Constituent Assembly, is connected to the context of the transition to democracy. In this context the failure of the Public Financing Pattern of social politics adopted in the military regime was recognized. Then a space for propositions that aimed at a Financing Pattern closer to the used in the social-democracy was opening. And so the Public Fund - the main pressuposition of feasibility of the social activities, and especially of the approved constitutional changes, must be directed to the popular interest. However this redirecting of Public Fund has found resistences and presented setbacks, which not only recover the vitiated and distorted financing mechanisms, but have also disfigured the model of the Single Health System proposed in the Health Care Reform, turning it into a kind of perverse caricature.
 
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Publishing Date
2018-02-01
 
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