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Equity and service contracting in the Brazilian Public Health System (SUS)

Grant number: 11/20641-5
Support type:Regular Research Grants
Duration: August 01, 2012 - January 31, 2015
Field of knowledge:Humanities - Political Science - Public Policies
Principal researcher:Vera Schattan Ruas Pereira Coelho
Grantee:Vera Schattan Ruas Pereira Coelho
Home Institution: Centro Brasileiro de Análise e Planejamento (CEBRAP). São Paulo , SP, Brazil
Assoc. researchers: Daniel Belik ; Fabiola Fanti ; Felipe Szabzon ; Laura Trajber Waisbich ; Marcelo Francisco Dias ; Maria Luiza Levi Pahim


The Brazilian National Healthcare System (SUS) has been positively evaluated in relation to the evolution of basic indicators like infant mortality and the expansion in vaccine coverage, yet it remains heavily criticized when it comes to the equity of the system, the quality of attendance or the waiting time for more complex medical procedures. The literature suggests that this paradox reflects both the good results achieved by the decentralization of Brazil's healthcare system, and the problems faced by state and municipal public officials in managing systems that involve the regional coordination of healthcare services with varying levels of complexity. This situation indicates the need to strengthen the municipal systems and regional networks, but there is still very little consensus on how to proceed. This project seeks to contribute to this discussion by examining two debates. One, approached from the viewpoint of Public Administration, concerning the potential to improve public management through 'service contracting', a system where the public manager presents a management contract that defines targets relating to the range, quantity and quality of healthcare services to be supplied by state or private non-profitmaking providers. The other, approached from the viewpoint of Politics, concerning inequalities and the role of a more equitable access to public policies in its reduction. These aims in mind, the project will anaylze services contracting processes currently being implemented in the State of São Paulo, focusing on how they contribute to (1) structuring the network of public health services, and (2) increasing the level of equity in access to public healthcare services. The hypothesis to be explored in our research is that where contracting processes help produce management structures with an effective capacity to perform the functions of planning, design and arbitration - results expected from this process but rarely demonstrated - there is more chance of improving the structure of the regional network with a positive impact on promoting a more equitable access to public healthcare services. (AU)

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Scientific publications
(References retrieved automatically from Web of Science and SciELO through information on FAPESP grants and their corresponding numbers as mentioned in the publications by the authors)
VERA SCHATTAN P. COELHO; JANE GREVE. As Organizações Sociais de Saúde e o Desempenho do SUS: Um Estudo sobre a Atenção Básica em São Paulo. Dados, v. 59, n. 3, p. 867-901, . (13/07616-7, 11/20641-5)
GREVE, JANE; RUAS PEREIRA COELHO, VERA SCHATTAN. Evaluating the impact of contracting out basic health care services in the state of Sao Paulo, Brazil. HEALTH POLICY AND PLANNING, v. 32, n. 7, p. 923-933, . (13/07616-7, 11/20641-5)

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