Áquilas Nogueira Mendes

The process of building up regional health management in the state of São Paulo: subsidies for analysis

Este artigo apresenta os resultados gerais da pesquisa sobre o processo de construcao da gestao regional no estado de Sao Paulo, durante a discussao do COAP/redes de atencao, com o intuito de fornecer subsidios para a compreensao deste processo de pactuacao regional da saude, com enfoque nas regioes de saude de Bauru, Baixada Santista, Grande ABC e Vale do Ribeira, no estado de Sao Paulo. Alem dos resultados apresentados sobre as regioes de saude estudadas, a metodologia utilizada no desenvolvimento da construcao dos perfis das regioes constitui em si uma proposta metodologica de analise de perfis regionais de saude. A primeira parte do artigo apresenta a metodologia geral adotada para a analise das regioes de saude; a segunda, abrange os resultados e a discussao da pesquisa, organizados em dois itens. O primeiro destes itens refere-se a analise dos perfis das cinco regioes de saude pesquisadas no Estado. O segundo, analisa os principais aspectos do processo de pactuacao regional da saude em Sao Paulo, destacando potencialidades e limites, a partir de entrevistas realizadas com gestores municipais e apoiadores do Conselho de Secretarios Municipais de Saude de Sao Paulo dessas regioes.

Renúncia fiscal (gasto tributário) em saúde: repercussões sobre o financiamento do SUS

ABSTRACT In the context of financial capitalism, marked by a direct transfer of rights to health to market, fiscal waivers (tax expenditures) present as gears that extend the power of private ins -titutions in the health sector, damaging Brazilian Unified Health System financing. It is remarka -ble the legal framework developed in Brazil, that provides permanent extension of tax waivers, especially in this sector, contributing to increasing coverage of health plans. This article highli-ghts the effective transformation of the right to health in guarantee of consumption of products and services, denoting the clear process of commodification that this policy has been suffering. EORDS Fiscal waiver; Health tax expenditure; SUS financing. SAUDE DEBATE | rio de Janeiro, v. 39, n. 105, p.491-505, aBr-JUn 2015 491 Renuncia fiscal (gasto tributario) em saude repercussoes sobre o financiamento do SUS Fiscal aiver tax spendin in health: effects on financin of the SUS Aquilas Mendes 1 , Jose Alexandre Buso Weiller

A saúde pública brasileira no contexto da crise do Estado ou do capitalismo

This article aims to analyze the trend of Brazilian universal public health in the context of the structural crisis of capitalism, articulating the interests of capital and of the State, without being possible to refer to a crisis of the Modern State. To do so, the article is organized into two parts. The first part seeks to analyze the nature of the crisis, identifying trends in the development of capitalism, especially in the last decades of the 20th century and in the first decade of the 21st century, with emphasis on the Marxian law of the tendency of the rate of profit to fall and the dominance of the interest-bearing capital. The second part discusses the impacts of this crisis on the universal right to health in Brazil, especially since the 1990s, confirming the uncertainties of the funding of the Brazilian National Health System (SUS) and the growing movement of capital appropriation on the resources of social policies of social security rights, especially related to health. Lastly, final considerations are presented, including proposals to address this situation of instability and underfunding of the health system.

O fundo público e os impasses do financiamento da saúde universal brasileira

Este artigo objetiva rever a sistematizacao teorica sobre o fundo publico e seu papel no âmbito do capitalismo contemporâneo com a finalidade de contribuir para uma analise aprofundada sobre os impasses do financiamento da seguridade social e da saude. A primeira parte discute os conceitos do fundo publico e sua relacao com o financiamento das politicas sociais, identificando a visao a respeito do fundo publico como “antivalor”, bem como aborda a critica mais presente na literatura recente sobre sua abordagem. Com base nessa analise, indaga-se, no contexto do capitalismo contemporâneo financeirizado e da atual crise do capital, quais sao as fragilidades que o conceito de antivalor do fundo publico para as politicas de direitos sociais vem enfrentando. A segunda parte, a luz da primeira, trata da trajetoria do financiamento da seguridade social e do Sistema Unico de Saude (SUS) nos anos 1990 e 2000, com destaque para as dificuldades enfrentadas.

Custos da cadeia de procedimentos no tratamento do infarto agudo do miocárdio em hospitais brasileiros de excelência e especializados

OBJECTIVE: To present the methodology and the results of a field survey to assess the chain costs of procedures for treatment of acute myocardial infarction (AMI), carried out in 11 Brazilian reference and specialized hospitals. METHODS: The cost assessment used the cost per procedure and per pathology systems. The procedures associated with the treatment of AMI were organized and their logical sequence (protocols) was used to create a flowchart. Data collection tools gathered information on prices and quantities in 2008 (private, health insurance, SUS, and Brazilian Medical Association - AMB price lists), as well as the applicable costs. RESULTS: Overall, the total cost of the procedures involving the standard treatment of AMI was R

Outsourcing and "dismantling" of steady jobs at hospitals

12,873.69, if percutaneous coronary intervention (PCI) did not involve stent use. If the stent becomes necessary, the cost increases to R

As formas político-jurídicas do Estado no capitalismo contemporâneo e as renúncias fiscais em saúde

23,461.87. CONCLUSION: Among the results, we emphasize the fact that the costs of the more expensive procedures did not present statistically significant variations between hospitals, regardless of their location, predominant clientele or legal nature, and the fact that hospitals that treat predominantly users of the Brazilian Unified Health System registered the lowest costs, albeit not statistically significant regarding the entire chain of procedures associated with the pathology.

O processo de regionalização do SUS e a autonomia municipal no uso dos recursos financeiros: uma análise do estado de São Paulo (2009-2014)

OBJECTIVEnTo relate hospitals organizational structure as the core of a web of outsourced services and flexible employment bonds among healthcare professionals in the context of finance capitalism, analyzing work arrangements based mainly on the type of employment bond.nnnMETHODnQualitative research through ethnography, interviews, data analysis, and case studies. The case studies were concentrated in 3 hospitals located in the São Paulo metropolitan region under different management types: public administration; outsourced administration via a healthcare social organization (HSO); and private administration.nnnRESULTSnThis study highlights a trend in outsourcing, dismantling of steady jobs, and shaping working relations asymmetrically in terms of healthcare professions.nnnCONCLUSIONnThese aspects are characteristic of contemporary capitalism and post-Fordist work organization. In this context, the state under sponsorship cripples the very existence of an effective human resources policy, creating a favorable environment for outsourcing and flexibility of employment bonds among healthcare workers.nnnOBJETIVOnRelacionar a estrutura organizativa dos hospitais como núcleo de uma rede de serviços subcontratados e a flexibilização dos vínculos contratuais dos profissionais de saúde no contexto de capitalismo financeirizado, analisando os regimes de trabalho condicionados centralmente pelo vínculo empregatício.nnnMÉTODOnPesquisa qualitativa através de etnografia, realização de entrevistas, análise de dados e utilização de estudo de caso. Os estudos de caso concentram-se em três hospitais localizados Região Metropolitana de São Paulo com gestões distintas: administração pública; administração terceirizada para Organização Social de Saúde (OSS); e administração privada.nnnRESULTADOSnDestacamos a tendência da terceirização, do desmonte do emprego estável e a conformação de relações trabalhistas assimétricas para as profissões em saúde.nnnCONCLUSÃOnEsses aspectos são característicos do período do capitalismo contemporâneo e da organização pós-fordista do trabalho. Nesse contexto, o subfinanciamento do Estado inviabiliza uma política de recursos humanos efetiva, configurando o ambiente propício para as terceirizações e flexibilidade do vínculo empregatício para os trabalhadores de saúde.OBJECTIVE To relate hospitals organizational structure as the core of a web of outsourced services and flexible employment bonds among healthcare professionals in the context of finance capitalism, analyzing work arrangements based mainly on the type of employment bond. METHOD Qualitative research through ethnography, interviews, data analysis, and case studies. The case studies were concentrated in 3 hospitals located in the Sao Paulo metropolitan region under different management types: public administration; outsourced administration via a healthcare social organization (HSO); and private administration. RESULTS This study highlights a trend in outsourcing, dismantling of steady jobs, and shaping working relations asymmetrically in terms of healthcare professions. CONCLUSION These aspects are characteristic of contemporary capitalism and post-Fordist work organization. In this context, the state under sponsorship cripples the very existence of an effective human resources policy, creating a favorable environment for outsourcing and flexibility of employment bonds among healthcare workers.

Mercantilização nas reformas dos sistemas de saúde alemão, francês e britânico

When analyzing the health situation in Brazil, one can notice the reinforcement ofxa0a logic that turns the right to health assistance into a hostage of the dynamics of contemporaryxa0capitalism. From this perspective, the waiver of tax collection in health in the Brazilian Statexa0stands out, leading to tax exemptions that result from the deduction of expenses with health insurancexa0and similes from income tax, as well as fiscal grants to private non-profit entities (philanthropicxa0hospitals) and the chemical-pharmaceutical industry. Thus, this article criticizes thosexa0legal provisions, which stress the subservience relation of the State to the logic of capital, identifying,xa0socio-historically, how these forms are directly and indirectly dilapidating the financing ofthe Unified Health System.

Análise do financiamento e gasto do Sistema Único de Saúde dos municípios da região de saúde Rota dos Bandeirantes do estado de São Paulo, Brasil

This article aims to understand the effects that the financing of actions and public programs linked to the health care thematic networks have on the transfers of federal resources to the Municipal Health Fund within the Block of financing of the Medium and High Complexity (MHC), in order to identify to what extent the implementation of these networks restricted the autonomy of municipal entities and which were prioritized in relation to the volume of resources effectively transferred. By and large, one has to question if the transfers linked to thematic networks meant an increase to the resources of the MHC Block, keeping thus the most autonomous portion of use of municipal entities preserved.