Emerson Elias Merhy

O acolhimento e os processos de trabalho em saúde: o caso de Betim, Minas Gerais, Brasil

The subject of this paper is changes in health care when user embracement is used as a strategic aim. According to the user embracement concept, health care clients are the center of the health services organization, including the following: 1) care for everyone seeking it, thus guaranteeing universal accessibility; 2) reorganization of the work process, such that its central thrust is shifted from the physician to the multiprofessional staff, or user embracement team, in charge of hearing users and becoming involved in solving their health problems; and 3) solidarity, humanity, and citizenship as parameters for the relationship between health care users and providers. The research showed improvement of non-medical health care productivity and greater accessibility by users. After nine months, the user embracement team solved 50% of the health problems themselves. The above-mentioned effects were also linked to workers motivation, leading to greater creativity in the work process.

Managed care in Latin America: the new common sense in health policy reform

This article presents the results of the comparative research project, Managed Care in Latin America: Its Role in Health System Reform. Conducted by teams in Argentina, Brazil, Chile, Ecuador, and the United States, the study focused on the exportation of managed care, especially from the United States, and its adoption in Latin American countries. Our research methods included qualitative and quantitative techniques. The adoption of managed care reflects the process of transnationalization in the health sector. Our findings demonstrate the entrance of the main multinational corporations of finance capital into the private sector of insurance and health services, and these corporations intention to assume administrative responsibilities for state institutions and to secure access to medical social security funds. International lending agencies, especially the World Bank, support the corporatization and privatization of health care services, as a condition of further loans to Latin American countries. We conclude that this process of change, which involves the gradual adoption of managed care as an officially favored policy, reflects ideologically based discourses that accept the inexorable nature of managed care reforms.

O ato de governar as tensões constitutivas do agir em saúde como desafio permanente de algumas estratégias gerenciais

O autor procura sintetizar, neste ensaio, o que tem animado, recentemente, suas reflexoes sobre o ato de governar estabelecimentos de saude, em varios artigos e livros, tomando como desafio a tentativa de imprimir mudancas no dia-a-dia do fabricar os modelos de atencao a saude, no interior das praticas dos trabalhadores, mesmo nao tendo grande concentracao de poder para a transformacao, procurando entao compreender como e por onde produzir poderes. Como explorar terrenos de potencias no campo da saude que estao presentes na conformacao tensional de seu territorio de acao, fazendo-se uso das distintas ferramentas gerenciais disponiveis no campo das ciencias e tecnicas de governo, na saude. Utiliza a atencao gerenciada para desenvolver certas analises.

Medicina social latinoamericana: aportes y desafíos

This piece presents and analyzes a number of issues related to social medicine: the context of the emergence of social medicine; the differences between social medicine and public health; the theories, methods, and debates in social medicine; the main subjects or problems considered in social medicine; and the difficulties of disseminating the concepts of social medicine among English-speaking persons and among medical and public health professionals in general. Latin American social medicine has challenged other views by contributing to an understanding of the determinants of the health-disease-health care process and by using theories, methods, and techniques that are little known in the field of public health. Introducing Latin American social medicine, especially among English speakers, will be difficult due to the conceptual complexity of this field for persons who are accustomed to the theoretical framework of public health and medicine and also due to skepticism concerning research coming from the Third World. A multidisciplinary team is facing this challenge through two primary initiatives: 1) the creation of an Internet portal and database where there are structured abstracts in English, Portuguese, and Spanish of books, book chapters, and articles on social medicine and 2) the electronic publication of two journals on Latin American social medicine.

Perspectivas da regulação na saúde suplementar diante dos modelos assistenciais

O atual trabalho discute os avancos e limites da regulacao publica da saude suplementar e propoe mapear a integralidade da assistencia pelo acompanhamento da linha do cuidado. Discute um modelo no qual o usuario deveria ser acompanhado segundo determinado projeto terapeutico instituido, comandado por um processo de trabalho cuidador, e nao por uma logica indutora de consumo. Esse mecanismo visaria assegurar a qualidade da assistencia prestada.

A mortalidade infantil em Belo Horizonte, Minas Gerais, Brasil, por área de abrangência dos Centros de Saúde (1994-1996)

Geographic analysis of health conditions highlights regional and intra-urban inequalities. This study aims to identify intra-urban discrepancies in the city of Belo Horizonte, studying the infant mortality coefficients (IMC) in the various areas of the metropolitan area and evaluating their evolution from 1994 to 1996. The study uses data from 1994 to 1996 regarding birth and death records (from the SINASC and SIM registries). It also uses thematic maps related to geographic coverage areas of municipal health centers to demonstrate differences in infant mortality coefficients. The empirical Bayesian method was applied to correct possible random fluctuation in IMC due to small and unstable numbers. A 24.4% reduction in the overall coefficient was observed in the city from 1994 to 1996. Decreases also occurred in the health center coverage areas. In 1994, eight areas presented an IMC above 50/1,000, while in 1996 no area reached that coefficient. In 1994, 29 areas presented an IMC from 35 to 50/1,000, as compared to only four areas in 1996. In 1996 there were more areas with IMC below 35/1,000 as compared to 1994. In 1996, more homogeneity was observed in IMC distribution and hence a reduction in intra-urban inequalities.

Saúde pública, rede básica e o sistema de saúde brasileiro

This article focuses on the development of public health in Brazil, with the aim of analyzing the present process of decentralization of health care. The authors argue that the neoliberal or conservative position is unable to offer a reasonable solution to problems in the health care system. On the other hand, the reformist position concentrates its attention on the health system and its administration, taking as its model a positivistic approach to natural and administrative sciences. The authors further argue that only a radical change in the prevailing medical paradigm and a predominance of social over biological aspects would meet the health needs of the population.

La atención gerenciada en América Latina. Transnacionalización del sector salud en el contexto de la reforma

This article presents the results of the comparative research project Managed Care in Latin America: Its Role in Health Reform. The project was conducted by teams in Argentina, Brazil, Chile, Ecuador, and the United States. The studys objective was to analyze the process by which managed care is exported, especially from the United States, and how managed care is adopted in Latin American countries. Our research methods included qualitative and quantitative techniques. Adoption of managed care reflects transnationalization of the health sector. Our findings demonstrate the entrance of large multinational financial capital into the private insurance and health services sectors and their intention of participating in the administration of government institutions and medical/social security funds. We conclude that this basic change involving the slow adoption of managed care is facilitated by ideological changes with discourses accepting the inexorable nature of public sector reform.

A pediatria social e as suas apostas reformistas

This article reflects on the constitution of Social Pediatrics in Brazil, viewing it as a movement for reform in childrens health care involving teaching, services, and pediatric practice. The article includes a historical and bibliographical review of the Social Pediatrics field and the provision of childrens health care, analyzing its relations with movements for the reform of medical education and health care and its conceptual framework, including several authors definitions and formulations on the theme.

Mapas analíticos: una mirada sobre la organización y sus procesos de trabajo

The center of the discussion that this paper tries to face is the challenge of a method. An analytical look is searched for about the health organizations that have a mode of production depending on the alive work in action, which in its own, provides a high complexity to the scene, since this alive work, while being operated in action in the work processes, contains a great power to form networks with a high capacity of subjectivity. We suggest the unions of workers build the cartography: a) the maps of conflicts, b) the maps of unusual acts, c) the maps of useless acts, and from these maps, we may proceed with the discussion, analysis and self-analysis of the processes lived in the work situation. Through this experience, it was proved the efficiency of the analytical maps as cartographic tools. Applied to the work processes, we captured the continuous and non-continuous movements of the alive work in its dynamics, also revealing the affection and manifestations of desire in the production of the reality. These maps had the function of the lens of the cartographer to visualize the work process and the production of reality in its micropolicy.