Notas sobre o futuro do SUS: breve exame de caminhos e descaminhos trilhados em um horizonte de incertezas e desalentos

Abstract

This article reflects on the future of the Brazilian Unified Health System (SUS, acronym in Portuguese), based on the foresight exercises conducted by the Brasil Saúde Amanhã initiative of the Oswaldo Cruz Foundation. The text briefly reviews some paths followed by the SUS as referred to in the Federal Constitution of 1988. It highlights the movement towards the decentralization of care and the constraint of health financial resources that reduced policies of increasing public expenditures. It examines the public and private arrangements for financing and provision of services that have resulted in sectoral privatization, mainly from economic policies articulated with concession of fiscal benefits. It analyzes the changes in the public sector financing through successive constitutional amendments that resulted in the weakening of established social protection policies, particularly of the health sector. For the future, the text considers population aging and analyzes trends in the epidemiological profile, with consequent changes in the health care paradigm. The article concludes by pointing out the consequences of fiscal strangling in the organization of the healthcare system and the need to reverse legal provisions that hamper the fulfillment of the constitutional mandate for equity and universality.

A retomada do processo de implementação da Política Nacional de Educação Permanente em Saúde no Brasil

“…This process has placed the need to promote changes/transformations in the staff training, either in undergraduate and postgraduate courses, and in the scope of services, through actions of permanent education, which accentuated the concern with the relations between the institutions that make up the personnel training system and the health system 5,6 , a topic that challenges scholars, managers and health professionals.…”

A crise financeira e a saúde: o caso do município do Rio de Janeiro, Brasil

“…The guarantee of public subsystem financing, the redefinition of the public-private articulation, which has favored the market through tax incentives and subsidies, and the reduction of income, power and health inequalities, are issues to be overcome [2][3][4][5] . While SUS expenses increased by 0.5% in real values from 2012 to 2016, gross revenue from health plans and insurance in the same period grew by 27.0% 1 .…”

“…Although health is part of social security in Brazil, assuming the condition of a universal right provided for in the 1988 Constitution, the country is at odds with others with universal systems, especially concerning government health expenditure and provision of services 1 .…”

“…The new tax regime approved by most House and Senate parliamentarians freezes federal primary spending for the next 20 years, severely affecting established social rights. EC 95 is estimat-ed to decrease the proportion of federal health spending from 1.8% to 1.45% or 1.2% or 0.99%, depending on the GDP growth rate 1 . Brazilian fiscal austerity and the consequent prospect of reduced investment in social programs (Bolsa Família Program and the ESF) may affect child mortality, as poverty is one of the most critical social determinants of child health.…”

Subfinanciamento e orçamento federal do SUS: referências preliminares para a alocação adicional de recursos

“…The structural issue of the previously addressed chronic SUS underfunding process is also present in the reflection proposed by Noronha et al 10 : "A structured, functional and not underfunded Unified Health System creates many difficulties, if not makes it unfeasible, for the capital to operate both in the health insurance market and in the provision of private health services".…”