La atención gerenciada en América Latina. Transnacionalización del sector salud en el contexto de la reforma

Abstract

This article presents the results of the comparative research project "Managed Care in Latin America: Its Role in Health Reform". The project was conducted by teams in Argentina, Brazil, Chile, Ecuador, and the United States. The study's objective was to analyze the process by which managed care is exported, especially from the United States, and how managed care is adopted in Latin American countries. Our research methods included qualitative and quantitative techniques. Adoption of managed care reflects transnationalization of the health sector. Our findings demonstrate the entrance of large multinational financial capital into the private insurance and health services sectors and their intention of participating in the administration of government institutions and medical/social security funds. We conclude that this basic change involving the slow adoption of managed care is facilitated by ideological changes with discourses accepting the inexorable nature of public sector reform.

Disputas inter-capitalistas, biomedicalización y modelo médico hegemónico

“…These analyzes, as well as our research on the financialization of the health sector, operating since the 1980s, which has resulted in the formation of the medical-industrial-financial complex, serve as a framework for this article. 2 The formation of the medical-industrial-financial complex refers to the penetration of the financial capital as an administrator not only of medical insurance, but also of health care services (hospitals, dialysis centers, home care services, diagnostic and treatment centers, emergency services, among others). This process is highly developed in the United States (US), and present in some Latin American countries.…”

“…Part of the shift in the collective common sense was focused on presenting health care fund managers as smart buyers, able to rationalize excessive consumption, negotiate prices and coordinate health care, and increasing quality while reducing costs. 2 These objectives required the control of the main actors stimulating the demand, i.e. health care providers (health practitioners and diagnostic and treatment service providers) and producers of goods and services in the health sector, especially pharmaceuticals and medical technology companies.…”

Trajetória das relações público-privadas no sistema de saúde da Colômbia de 1991 a 2015

“…A reforma adotou uma concepção mercantil da saúde, a participação do setor privado no asseguramento e prestação de serviços, a focalização do financiamento estatal nos pobres e a segmentação de benefícios como estratégias para atingir a cobertura universal do seguro de saúde, acentuando a histórica fragmentação institucional, os traços corporativistas e a segmentação do sistema de saúde anterior. Os resultados deste estudo foram consoantes com trabalho de Cantu 22 , que aponta o papel do mercado como alocador de serviços sociais após as reformas da década de 1990; e com Iriart et al 23 e Amada et al 24 , que argumentam que a agenda de reformas da saúde na América Latina permitiu a expansão de empresas seguradoras privadas na administração dos fundos do seguro de saúde.…”

Las denuncias de los afiliados de las empresas de medicina prepaga presentadas ante la Subsecretaría de Defensa del Consumidor en Argentina, 2000-2008

“…La mayor parte de los trabajos fue realizado por investigadores norteamericanos 1,2,3 . En América Latina el interés por la problemática ha sido creciente, principalmente, a partir de los procesos de reforma de los sistemas de salud en los años 90 4,5,6,7,8 .…”