Search

The article addresses the present configuration of Brazil’s health system. Although it is defined as comprising universal access, hegemonic public funding and direct provision of care, today it is fragmented and under private sector hegemony, with strong inequity in health care provision. Comparison between health expenditure indicators in 26 emerging countries shows that state expenditures have been of lesser magnitude, even as compared with other emerging countries. Out-of-pocket expenditures are high and that compromises equity. The failures of Brazil´s health reform are seen as an outcome of the pattern of organization of domestic collective interests. It is argued that, as the Constitution proposed no veto against the market operating in the health sector, interests with greater voice have succeeded in imposing their preferences in decision-making arenas for private health care. The discussion is based on policy analysis literature and health system typologies. The data are analysed by descriptive statistics. [ABSTRACT FROM AUTHOR]

The paper discusses the development in Brazil of the field of Collective Health field as grounded on three principles similar to those of the policy sciences proposed in the US by H. Laswell in the 1950's: multidisciplinarity, resolution of problems and normativity. Since then, the idea of science applied to the improvement of the policy process spread under the name of policy analysis. While in the USA normativity was seen by political scientists as incompatible with science's core values, in Brazil this convergence originated the academic field of collective health in the 1970's when health reform movement, supported by political parties, labor unions and social movements, developed. With democratic regime and deep changes in the health sector, the use of scientific and analytical knowledge by decision makers got momentum in Brazil as well as the role of the collective health which joined knowledge production and political action. The paper shows that as the field developed, a double process occurred: on one hand, the support for policy oriented studies as well as of Abrasco in the assertion of the multidisciplinary and normative features of the collective health. On the other hand, in the sphere of academic accreditation, the epistemic disputes for scientific legitimating and the predominance of academic legitimacy based on biomedicine criteria affecting the access to financial resources and calling into question the normative and multidisciplinary principles that originated the field. [ABSTRACT FROM AUTHOR]