O municipalismo brasileiro e a provisão local de políticas sociais: o caso dos serviços de saúde nos municípios paulistas / The Brazilian municipalism and the provision of local social politics: the case of health services in the São Paulos municipalities

AUTOR(ES)
DATA DE PUBLICAÇÃO

2007

RESUMO

This thesis examines the Brazilian municipalism after the Constitution of 1988. It verifies the municipalities performance in the provision of local health services vis-à-vis the decentralization of this policy due to the creation of the SUS (Unified Health System). It argues that the process of health services decentralization developed during the 90s presented two different steps: the step of autonomist decentralization, between 1990 and 1998, when the municipalities were totally free to choose their own local health policies; and the step of the driven decentralization, after the creation of the Basic Assistance Floor - PAB, when the municipalities started receiving targeted incomes, which could be used exclusively for specific health programs, determined by the Health Department. However, as we demonstrate, the both steps were incapable to decrease the extant regional inequalities in what regards the supply, the access and the financing of municipal health services. To summarize, we demonstrate that the inequalities in health produced by our federalism were not balanced through the outline of policies that municipalized the health services. In addition we demonstrate that the arguments usually raised by the literature on federalism and municipalism in Brazil, which are critical to the "municipalist wave" and to the existence of thousands of small municipalities - which are very dependent to the transfers from the Municipalities Participation Fund (FPM) - are not sufficient to explain the production of local social policies, since such municipalities are not the ones which present the worst outcomes in the supply, access and financing of health services by the municipal managers. Finally, we demonstrate that the consortiums can be an efficient mechanism to overcome one of the main problems which are faced by the small and poor municipalities to provide health services: the access to services of higher complexity - which do not exist in many small municipalities - without causing the "negative free-riding", i.e., the transferring of clients to other municipalities without the correspondent financial retribution.

ASSUNTO(S)

municipalism descentralização federalismo federalism intergovernmental cooperation cooperação intergovernamental política de saúde decentralization municipalismo health policy

ACESSO AO ARTIGO

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