Reinventing Privatization: A Political Economic Analysis of the Social Health Organizations in Brazil

Abstract

The Brazilian state apparatus was reformed throughout the 1990s, influenced by New Public Management (NPM). NPM was embodied in the health care sector by the creation of Social Health Organizations ( Organizações Sociais de Saúde or OSS), private non-profit entities to provide welfare services. We performed a systematic review of the literature outlining the origins and role of OSS in Brazil. Our selected articles (peer-reviewed) cover the origins/performance of OSS and their services provision between 1998 and 2018, in English or Portuguese. Databases used were Lilacs, Bireme, Medline, Pubmed, and SciELO. We identified 4,732 articles applying a pre-defined set of descriptors, from which we selected 49 for analysis. The main findings reveal that NPM is the central theme of most articles about OSS in Brazil (n = 26). There is evidence corroborating our hypothesis that transferring management of public health care services to private non-profit organizations is a softer version of privatization as, although financing is kept public, the rationale and ethos of OSS services institutionally and operationally mimic the private sector. The practical consequence is that attainment of health care in Brazil ends up being neither fully commodified (based on ability to pay) nor fulfilled as a citizen’s right following its national constitution.

An evidence-based primary health care intervention to address domestic violence against women in Brazil: a mixed method evaluation

“…Family health teams in the clinics consist of a doctor, a nurse, two nursing assistants and six community health agents responsible for 800-1000 families 13,14 . The PHC clinics are managed in SP by Social Organizations (Organizações sociais -OS), private not-for-pro t organisations which receive from the National Health System (SUS) to deliver performance management focused on maximising the number of consultations 15 .…”

An evidence-based primary health care intervention to address domestic violence against women in Brazil: a mixed method evaluation

“…Family health teams in the clinics consist of a doctor, a nurse, two nursing assistants and six community health workers (CHW) responsible for 800—1000 families [ 17 , 18 ]. In SP, the PHC clinics are managed by Social Organizations (Organizações sociais—OS), private not-for-profit organisations through contractual agreements with the National Health System (SUS) to deliver performance targets focused on maximising the number of consultations [ 19 ].…”

Shifting the management model of Brazilian health services: perceptions of major stakeholders on the participation of the private sector in public hospital administration

“…In the case of Brazil, this discussion first reverberated after the plan for the reform of the state bureaucracy proposed by Bresser-Pereira, tied to the idea of a minimal state [ 1 ] . As a result, the introduction of private- or third-sector organizations in the management of the country’s healthcare increased significantly, especially during the last decade, when similar models were adopted to those used by countries such as Canada, Spain, England, and France [ [2] , [3] , [4] , [5] ] .…”