A crise do federalismo cooperativo nas políticas de saúde no Brasil

Abstract

This article analyzes the main aspects of federative political systems according to classical and contemporary theories and the case of the Brazilian health sector. Brazil presents a federative configuration founded on cooperation as a result of the democratic transition in which the consensual dimensions of democracy were strengthened. On the other side, the weakening of the madisonian aspects of separation of the functions and judicial review compromised the policy coordination and the accountability in health policy. It is argued that cooperative aspects are compromised by the singularity of municipalities with federative power without the creation of compensatory institutions of the competitive deficits. KEYWORDS

Obstáculos políticos à regionalização do SUS: percepções dos secretários municipais de Saúde com assento nas Comissões Intergestores Bipartites

“…As we have seen, what is observed is that it shrinks the capacity of Brazilian federalism to produce cooperative effects on the health system 25 . Besides aligning in this direction, results of this study shed light on the knowledge of motivating factors of political action by important decision makers in the system.…”

“…It is the low capacity that the SUS in regionalizing health care toward reducing the great regional inequalities pointed out by the very specialized literature previously discussed and objectively defined in a recent study 25 . Thus, analyzing the perceptions of decision-makers in the main collegiate bodies of the SUS is methodologically quite advantageous to achieve the general objective of the study.…”

Regionalização da saúde no Brasil na perspectiva dos gestores municipais: avanços e desafios

“…Observou-se neste estudo que as regiões possuem redes de urgência e emergência, porém há que se considerar que são desenvolvidas de forma bastante diversa em todo o país 36 , dependendo do contexto específico, do grau de adesão estadual e municipal à política, da estrutura do sistema de saúde local e da organização em vigor antes da rede de serviços 37 .…”

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

“…This study falls within a line of research created in 2013 that examines federalism in Brazil, covering topics such as: the decentralization crisis in the SUS 1 ; political obstacles to regionalization 2 ; regional inequalities based on an analysis of health regions 3 ; the implementation of the Public Actions Organizational Contract (Contrato Organizativo de Ações Públicas -COAP) 4 ; public participation and patterns of deliberative democracy 5,6 ; and decentralization and regulation in relations between public and parastatal assets 7 .…”