Mercantilização nas reformas dos sistemas de saúde alemão, francês e britânico

Abstract

Since the 1980s, European health systems have undergone several reforms, with emphasis on the tendency of their commodification. The objective of this article is to demonstrate how market mechanisms were implemented in the functioning of these systems, german, british and french - from the 1980s. The "mercantile" reforms were justified on the premise that the insertion of market logic could both reduce the need for public spending and increase the efficiency of existing expenditure. The work presents different forms of commodification implemented in the reforms, with the distinction between processes of explicit commodification, in which there is an effective increase in private, and implicit presence, in which there is incorporation of principles from the private sector in the public system, both in financing and in the provision of health services. In addition to detailing the different ways in which this phenomenon is expressed, the article briefly presents the potential negative effects of this process for health systems, especially in terms of access and equity, stating that the initial assumptions surrounding commodification (cost reduction and efficiency improvement) appear to be false.

Alteridade ou austeridade: uma revisão acerca do valor da equidade em saúde em tempos de crise econômica internacional

“…The most recurrent topic in the studies, the health sector commercialization and reforms, is justified from the perspective of assessing which measures adopted during the capitalism crises were successful ones: freedom of choice, for instance, did not lead to an increase in efficiency, nor the models of remuneration to service pro-viders and fragmentation and privatization of health services led to an increase in the effectiveness of health levels 12,23 . According to the hypermodern perspective 42 , the power of choice, decision-making, the individuals' autonomy in their life relationships and interactions, provided the unsustainable weight of individual responsibility and insecurity regarding the future.…”

“…The concepts of commercialization and privatization of services are addressed, pointing out the main mechanisms used, their consequences for equity and efficiency, as well as future trends. Commercialization has been defined as a broader process than privatization, as it encompasses the use of private logic within public health systems by increasing the direct participation of the private sector as a provider of services and of private resources in financing, as well as the use of liberal principles of management, remuneration and organization of systems 23 . The main trends found in the reforms were: the implementation of universal systems, public contract models; separation between buyers and providers, choice of providers, regulated competition between providers and buyers, strengthening of the PHC, with the capacity to negotiate and purchase secondary services, restriction of hard technology coverage (protocols) 24 .…”

Saúde Bucal em sistemas universais de saúde: análise comparativa do Brasil e Reino Unido

“…O seguro privado é usado para atendimentos não cobertos pelo NHS, para acessar leitos privados em hospitais públicos ou serviços em hospitais privados, estes últimos procurados pela população de maior renda (Ferreira & Mendes, 2018).…”

“…O NHS foi criado logo após a implantação da política de bem-estar social, Welfare State, em 1945, com princípios de proteção social e prestação de serviços a toda população, incluindo saúde, educação e habitação (Ferreira & Mendes, 2018;Giovanella & Stegmüller, 2014). Em 1991, o NHS passou por reforma no âmbito de um governo mais conservador, desenvolvendo uma lógica de mercado interno com competição, ainda que regulada, e manteve a atenção primária como porta de entrada prioritária (Tanaka & Oliveira, 2007).…”

Regionalização dos sistemas de saúde como resposta às desigualdades territoriais: um debate necessário

“…The debate on the context of neoliberalism and transformations in administration indicates the need for changes in the nature of management on its different scales worldwide. The assumption that the market logical can decrease public expenditures by increasing efficiency has not been confirmed in studies indicating the potential negative effects of these processes, producing both an explicit commodification in outsourcing and an implicit commodification by incorporating principles from the private sector into the public sector in business processes 6 . The experience of the city and state of São Paulo in hiring Social Organizations (OS) to manage health services, including primary care units, has indicated this effect in the impossibility of producing induced care via management contract targets.…”