[Policy-making tiers of the Unified Health System (SUS) in the State of Rio de Janeiro and the decision-making process]. / As instâncias colegiadas do SUS no Estado do Rio de Janeiro e o processo decisório.

The literature concerning governmental policy-making generally encompasses the entire policy-making field. This study focused on one particular aspect of this process in the State of Rio de Janeiro, from January 1998 to July 1999: the formal decision-making tiers represented by State Health Council (CES) and the Bipartite Inter-Managerial Commission (CIB), as well as the relationships between these councils and the State Health Secretariat (SES), which holds political responsibility for approving or rejecting decisions and is thus a key player in the implementation of the Unified Health System (SUS) at the State level. Despite the political confrontation among the SES, CIB, and CES, we have observed that the new design in health policy vis-à-vis the decision-making process has fostered increasing influence by social actors involved in decisions and that the negotiated arrangements, although the result of a given correlation of forces, have favored the democratization of policy-making in the health sector.

Health sector reform in Brazil: a case study of inequity.

Health sector reform in Brazil built the Unified Health System according to a dense body of administrative instruments for organizing decentralized service networks and institutionalizing a complex decision-making arena. This article focuses on the equity in health care services. Equity is defined as a principle governing distributive functions designed to reduce or offset socially unjust inequalities, and it is applied to evaluate the distribution of financial resources and the use of health services. Even though in the Constitution the term "equity" refers to equal opportunity of access for equal needs, the implemented policies have not guaranteed these rights. Underfunding, fiscal stress, and lack of priorities for the sector have contributed to a progressive deterioration of health care services, with continuing regressive tax collection and unequal distribution of financial resources among regions. The data suggest that despite regulatory measures to increase efficiency and reduce inequalities, delivery of health care services remains extremely unequal across the country. People in lower income groups experience more difficulties in getting access to health services. Utilization rates vary greatly by type of service among income groups, positions in the labor market, and levels of education.

[Politics and social medicine in Chile: narratives concerning a difficult relationship]. / Politica e medicina social no Chile: narrativas sobre uma relacao dificil.

The article examines the conditions in Chile that fostered development of a social medicine doctrine defended by the left. This doctrine influenced the legal, institutional, and technical construction of the Servico Nacional de Saude (SNS) in 1952. Central to the workings of the democratic regime (up until 1973) and to the free and open public discussion of national projects of a socializing nature was a party system that encompassed the entire ideological spectrum. The pioneering creation of Workers Social Security in 1924 is underscored. Likewise of import was the emergence of transformational proposals regarding the health-assistance model that is consolidated. Ensuing conflicts were finally overcome following World War II, under the influence of England's National Health Service. Chilean political culture yielded the consolidation of lasting concepts in social medicine but created barriers to the project to build a universalized sanitary-medical system, intended to provide integral care to all citizens.