Consórcios intermunicipais de saúde: uma análise à luz da teoria dos jogos

Abstract

Sumário: 1. Introdução; 2. O Modelo básico; 3. Resolução: modelo 1 -com punição; 4. Resolução: modelo 2 -sem punição; 5. Extensão: um papel para a natureza; 6. Outras extensões; 7. Conclusão.Palavras-chave: saúde; municípios; consórcios.Código JEL: C72; H72; I18.O presente estudo analisa a formação e a sustentabilidade político-financeira dos Consórcios Intermunicipais de Saúde por meio de um jogo dinâmico de dois períodos com informação imperfeita, no qual dois prefeitos de municípios decidem quantoà adesão è a permanência no consórcio. São analisados dois modelos. No primeiro admite-se a suspensão do atendimento nas instalações do consórcioà sua população do município que abandonar a parceria. Já no segundo, considerando o princípio constitucional que estabelece o acesso universalàs ações e serviços de saúde, relaxa-se essa hipótese. O estudo evidencia uma forte tendênciaà instabilidade da associação no segundo modelo.The present article studies a new organizational structure in which neighboring health districts in Brazil form a partnership to jointly supply costly specialized health care services. Each district partially funds the organization. Depending on the partnership contract, a free rider problem arises. A district has the incentive to withdraw from the partnership if it can still benefit from its services, especially when political pressures for competing expenditures arise. The main conclusion is that the partnership sustainability is * Artigo recebido em nov. 2000 e aprovado em abr. 2002. Os autores agradecem a Mirta Bugarin e Mônica Viegas e aos dois pareceristas anônimos, cujos comentários e sugestões muito contribuíram para o aprimoramento deste artigo. Os autores assumem inteira responsabilidade pelos erros remanescentes.

Dificuldade de acesso a serviços de média complexidade em municípios de pequeno porte: um estudo de caso

“…This information corroborates what Teixeira et al 26 affirmed that in spite of the municipalities having benefited from the 1988 Constitution with the process of decentralization, they still continue to present major fiscal vulnerabilities. If on one side there was an increase in the sources for resources, on the other side the process of decentralization of public functions has been having a major impact on the finances of the federal entities.…”

Local Government Cooperation for Joint Provision: The Experiences of Brazil and Spain With Inter-Municipal Consortia

“…High unit provision costs, which suggest that there is scope for enhancing cost-effectiveness, are associated with a higher probability of participation in inter-municipal consortia for the provision of health care and transport in Brazil. In the case of health care, this finding confirms the predictions of a theoretical model developed by Teixeira et al (2003a and2003b) and Teixeira (2007). But in some cases, such as urban development in…”

“…Teixeira et al (2003a and2003b) and Teixeira (2007) developed a dynamic two-period game and found that technological parameters, such as scale effects in production and service delivery, as well as the scope for improvements in the quality of services, including through access by residents to a broader array of services, which are rewarded in the electoral process, provide strong incentives for local (elected) policymakers to participate. The probability of participation also depends on local income and preferences, which affect the level of spending on health care and the tax rate needed to finance service delivery, once a consortium is established.…”

Percepção dos gestores municipais de saúde relacionada à saúde ambiental: consórcio intermunicipal de saúde Cerrado Tocantins Araguaia

“…The implementation is not more effective only because of lack of work force. productivity, which would enhance the performance of professionals and increase the quality of the services provided (Rodrigues, 2012;Teixeira, 2003).…”