A "liberalização" do Serviço Nacional de Saúde da Inglaterra: trajetória e riscos para o direito à saúde

Abstract

The recent reform of the English National Health Service (NHS) through the Health and Social Care Act of 2012 introduced important changes in the organization, management, and provision of public health services in England. This study aims to analyze the NHS reforms in the historical context of predominance of neoliberal theories since 1980 and to discuss the "liberalization" of the NHS. The study identifies and analyzes three phases: (i) gradual ideological and theoretical substitution (1979-1990) - transition from professional and health logic to management and commercial logic; (ii) bureaucracy and incipient market (1991-2004) - structuring of the bureaucracy focused on administration of the internal market and expansion of pro-market measures; and (iii) opening to the market, fragmentation, and discontinuity of services (2005-2012) - weakening of the territorial health model and consolidation of health as an open market for public and private providers. This gradual but constant liberalization has closed services and restricted access, jeopardizing the system's comprehensiveness, equity, and universal healthcare entitlement in the NHS.

Médicos pelo Brasil: caminho para a privatização da atenção primária à saúde no Sistema Único de Saúde?

“…Importantly, there is no evidence that private or outsourced provision will be more effective or efficient than similar provision by the public sector 6,7,8 . Research on the subject is insufficient to conclude that these new management modalities in the health sector will produce better results in the quality or efficiency of provision (now so widely proclaimed), especially in middle and low-income countries, as demonstrated by Cochrane reviews 8 , and some studies have pointed to negative impacts in high-income countries like England 9 .…”

A methodology for apportioning federal SUS resources: the health needs index

“…In the 1990s, Carr-Hill et al 25 developed a new methodological proposal centered on the use of health services to estimate the potential demand for services generated by “health needs,” adjusting for the distribution of service offerings. Until now the English experience has served as a reference for any study of equitable methodologies for the apportionment of financial resources in health systems, even with the privatization process that the English NHS has been going through 26 .…”

“…Nos anos de 1990, Carr-Hill et al 25 elaboraram uma nova proposta metodológica centrada em dados de uso de serviços de saúde para estimar a demanda potencial dos serviços gerada pelas “necessidades de saúde”, ajustando pela distribuição da oferta de serviços. Enfim, até o presente momento, a experiência inglesa vem servindo de referência para qualquer estudo de metodologias equitativas de rateio dos recursos financeiros nos sistemas de saúde, mesmo com o processo de privatização que o NHS inglês vem sofrendo 26 .…”

30 anos de SUS: relação público-privada e os impasses para o direito universal à saúde

“…Welfare State no País. Por esse motivo, é percebido como um referencial precursor dos sistemas universais de saúde, figurando o necessário limite à influência do mercado para a garantia da universalidade da saúde13 .Pesquisadores apontam que a reforma social--democrata brasileira não se deu nos moldes do Welfare State dos países europeus, que mesmo mantendo o modelo capitalista, adotaram características e políticas redistributivas. O sistema de proteção social brasileiro conciliou focalização e universalização, em vez de reforçar esta última.…”