Comunidade epistêmica e a formação da reforma sanitária no Brasil

Abstract

Resumo: O artigo trata da análise política que sustentou a Reforma Sanitária Brasileira (RSB), responsável pela definição do Sistema Único de Saúde e pela ideia do direito universal contemplada pela Constituição Federal de 1988 (CF 1988. O texto ilumina a singular contribuição da comunidade de epistêmica dos sanitaristas para a formação da agenda de política pública redistributiva da saúde no contexto da redemocratização. O artigo revisa também as explicações para a fragmentação e influência do setor privado do sistema de saúde brasileiro, a despeito do sucesso institucional da proposta da universalização redistributiva. Destaca que a RSB não contemplava o veto à presença do mercado no setor saúde, o que reduziu os custos políticos para o setor privado impusesse suas preferências na Nova Democracia. O artigo conclui que a análise dos limites estruturais e institucionais para uma política pública redistributiva na saúde é ainda um desafio para a comunidade de especialistas da saúde coletiva. Palavras-chave: Reforma Sanitária; comunidade epistêmica; democratização; universalismo; privatização.

Health reform in Brazil: The sanitaristas as programmatic actors

“…Some authors describe this moment as a critical juncture, emphasizing that the economic recession provided the “immediate impetus” for the health reform (Lewis & Medici, 1998, p. 270). The context of political and economic crises in the 1980s would have changed the structure of political opportunities and broadened the scope of possible choices, hence interest groups found more favorable conditions in which to influence the political process (Costa, 2014, p. 812). Additional scholars, based on the study of Immergut (1992), discuss the health reform specifically with reference to the strategic use of institutional opportunities in Congress.…”

“…The creation of Abrasco in 1979 boosted residencies in preventive and social medicine to train health managers aimed to influence public policies (Nelsão interview in Faleiros et al., 2006, p. 67). Both civil entities were crucial for the diffusion of their reform program, as direct political activism was curtailed inside public organizations under authoritarian rule in the 1970s (Costa, 2014, p. 816).…”

“…The literature on health reform in Brazil is abundant, and there is a consensus about the role of the sanitaristas , defined as a collective actor established throughout the 1970s from the benches of preventive medicine schools, which gradually incorporated progressive healthcare professionals, union‐organized physicians, 1 intellectuals, and students of medicine (Dowbor, 2008; Escorel et al., 2005). The transformations social protection has undergone in recent decades corresponded to the main guidelines of their redistributive agenda that led to the constitution of a single, decentralized, integrated and participative health system (Costa, 2014, p. 820). The National Constituent Assembly debate between 1987 and 1988, at the end of the military regime, represented an opportunity for the pro‐reform movement to push for a major reform in Congress.…”

Austeridade, predominância privada e falha de governo na saúde

“…The significant growth in strength of the private-sector interests in the new democracy, however, was an event that the reformers did not anticipate 15 . The growing focalization of provision by the SUS in the strata of lowest income in the country indicates that public action, today, carries out merely distributive functions which abdicate from the project for a wide-ranging and systemic reform of the sector.…”

“…Over the course of the democratic transition of the 1980s, the members of the Constitutional Assembly accepted the model based on the predominance of public financing and direct provision by healthcare by the government 15 .…”