Transformações dos sistemas de saúde na era da financeirização. Lições da França e do Brasil

Abstract

Since the post-War period, social protection systems have experienced continuous reforms, either extending or, more often, reducing the scope and the scale of public provision. This paper seeks to present how healthcare systems have evolved both in France and in Brazil recently, in order to comprehend mechanisms through which financialization has been reshaping public care provision. This comparative analysis unveils distinct financialization dynamics of healthcare systems, built upon universalism principles. After featuring both systems, underlying their private dimension - either complementary or supplementary - the article points out how the financial sector is broadening its share in the supply of healthcare services. In what follows, the sector's process of internationalization/centralization is analyzed and lastly the regulatory role of the State in strengthening private provision is defined. Despite radically different institutional paths, the findings corroborate that in both cases finance is a driving force in reshaping the healthcare sector.

Financialisation and Public Health Systems: a new concept to examine ongoing reforms

“…In the private sector, financial companies and investors are replacing corporate and individual entrepreneurs as the leading agents of change in the industry. Traditional business models coexist with new structures where health goods and service providers are owned, controlled, or highly leveraged by finance (Angeli and Maarse, 2012;Bayliss, 2016;Cordilha and Lavinas, 2018;Vural, 2017;Hunter and Murray, 2019). There are also fewer and larger insurance companies, with a greater share occupied by the for-profit segment.…”

Public health systems in the age of financialization: lessons from the French case

“…9 Besides autonomous, the government has been exercising increasing control over the decisions of SS (Vahabi et al, 2020). 9 This relation is being reversed as non-profit institutions are losing ground for profit-oriented ones and mimicking their management principles (Abecassis et al, 2014;Cordilha and Lavinas, 2018).…”

“…The conversion of health financing and provision into investment opportunities brings structural transformations to the sector. As shown by recent research (Bayliss, 2016;Cordilha and Lavinas, 2018;Hunter and Murray, 2019;Lavinas and Gentil, 2018;Vural, 2017), this shapes decisions about what kind of services to provide, where, to whom, and at what costs and conditions. Moreover, it tends to distort the own meaning of health care provision, from prevention and healing to the maximization of investment returns.…”

Système de santé et de soins infirmiers en France

“…In the health sector, it relied on nonprofit and individual contributory insurance programs limited to only a portion of the population (particularly workers and their dependents). Despite these similarities, these systems have different ways of consolidating and articulating with the private sector 2 .…”