[Financialization and oligopolization of private teaching institutions in Brazil: the case of medical schools]. / Financeirização e oligopolização das instituições privadas de ensino no Brasil: o caso das escolas médicas.

There is a global trend towards the private sector's growing participation in training healthcare professionals, influenced by public policies. In Brazil, private medical schools have developed and expanded with government financing, more recently with support from the More Doctors Program. The study aimed to describe and analyze movements in the corporate reconfiguration of the educational sector, with trends towards oligopolization and financialization related to the recent expansion of medical education in Brazil. An exploratory qualitative and quantitative approach was used, associated with various methodological strategies, to overcome the limitations in access to information, with data collection from open-access secondary databases. The private sector now accounts for 60% of the course supply and 69% of enrollment in medicine, 31% of which is supplied by ten educational groups. The groups studied here highlight the dynamic educational market, mechanisms of financialization and concentration, and formation of an oligopoly in the supply of higher education, particularly in medical training. There has been a trend towards concentration of the supply of institutions of higher learning since 2000. The largest groups employ similar management strategies, expansion of their market share, shareholder format, business diversification, and uptake of investors and financial capital. Government programs like the More Doctors Program helped expand and concentrate the private educational sector with government transfers or advance financing. The trend has been towards oligopolization and financialization.

O contexto do artigo é a tendência global de aumento da participação do setor privado na formação de profissionais de saúde fortemente influenciada por políticas públicas. No Brasil, os cursos médicos privados se desenvolveram e expandiram com financiamentos governamentais e, recentemente, com o apoio do Programa Mais Médicos. O objetivo foi descrever e analisar os movimentos de reconfiguração empresarial do setor educacional com tendências de oligopolização e financeirização relacionadas à expansão recente do Ensino Médico no Brasil. Realizou-se abordagem qualiquantitativa, exploratória e descritiva associada a várias estratégias metodológicas, a fim de superar as limitações de acesso às informações, com coleta de dados em bases secundárias de acesso público. O setor privado é responsável pela oferta de 60% dos cursos e de 69% das vagas de medicina, das quais cerca de 31% são ofertadas por dez grupos educacionais. Nos grupos estudados destacam-se: dinamicidade do mercado educacional; mecanismos de financeirização e concentração; formação de oligopólio na oferta de Ensino Superior, em particular da formação médica. Tendência de concentração da oferta em instituições de Ensino Superior privadas desde os anos 2000. Similaridade dos maiores grupos nas estratégias de gestão, ampliação da participação no mercado, conformação do quadro de sócios, diversificação dos negócios e captação de investidores e capital financeiro. Programas governamentais, como o Programa Mais Médicos, contribuíram para a expansão e tendência de concentração do setor educacional privado com repasses de recursos públicos ou antecipação dos recursos. Tendência à oligopolização e à financeirização.

Tendencia global de aumento de la participación del sector privado en la formación de profesionales de salud, fuertemente influenciada por políticas públicas. En Brasil, los cursos médicos privados se desarrollaron y expandieron con la financiación gubernamental y, recientemente, con el apoyo del Programa Más Médicos. El objetivo fue describir y analizar los movimientos de reconfiguración empresarial del sector educacional con tendencias de oligopolización y financiarización, relacionados con la expansión reciente de la enseñanza médica en Brasil. Abordaje cualicuantitativo, exploratorio y descriptivo, asociado a varias estrategias metodológicas, con el fin de superar las limitaciones de acceso a la información, con recogida de datos en bases secundarias de acceso público. El sector privado es responsable de la oferta de un 60% de los cursos y de un 69% de las plazas de medicina, de las cuales cerca de un 31% se ofertan por parte de diez grupos educacionales. En los grupos estudiados se destacan: dinamicidad del mercado educacional; mecanismos de financiarización y concentración; formación de oligopolio en la oferta de enseñanza superior, en particular de la formación médica. Tendencia de concentración de la oferta en instituciones de educación superior privados desde el año 2000. Similitud de los mayores grupos en las estrategias de gestión, ampliación de la participación en el mercado, conformación del esquema de socios, diversificación de los negocios, así como la captación de inversores y capital financiero. Programas gubernamentales, como el Programa Más Médicos, contribuyeron a la expansión y tendencia de concentración del sector educacional privado con la transferencia de recursos públicos o anticipación de los mismos. Tendencia a la oligopolización y la financiarización.

Financeirização e oligopolização das instituições privadas de ensino no Brasil: o caso das escolas médicas / Financialization and oligopolization of private teaching institutions in Brazil: the case of medical schools / Financiarización y oligopolización de las instituciones privadas de enseñanza en Brasil: el caso de las escuelas médicas

O contexto do artigo é a tendência global de aumento da participação do setor privado na formação de profissionais de saúde fortemente influenciada por políticas públicas. No Brasil, os cursos médicos privados se desenvolveram e expandiram com financiamentos governamentais e, recentemente, com o apoio do Programa Mais Médicos. O objetivo foi descrever e analisar os movimentos de reconfiguração empresarial do setor educacional com tendências de oligopolização e financeirização relacionadas à expansão recente do Ensino Médico no Brasil. Realizou-se abordagem qualiquantitativa, exploratória e descritiva associada a várias estratégias metodológicas, a fim de superar as limitações de acesso às informações, com coleta de dados em bases secundárias de acesso público. O setor privado é responsável pela oferta de 60% dos cursos e de 69% das vagas de medicina, das quais cerca de 31% são ofertadas por dez grupos educacionais. Nos grupos estudados destacam-se: dinamicidade do mercado educacional; mecanismos de financeirização e concentração; formação de oligopólio na oferta de Ensino Superior, em particular da formação médica. Tendência de concentração da oferta em instituições de Ensino Superior privadas desde os anos 2000. Similaridade dos maiores grupos nas estratégias de gestão, ampliação da participação no mercado, conformação do quadro de sócios, diversificação dos negócios e captação de investidores e capital financeiro. Programas governamentais, como o Programa Mais Médicos, contribuíram para a expansão e tendência de concentração do setor educacional privado com repasses de recursos públicos ou antecipação dos recursos. Tendência à oligopolização e à financeirização.

There is a global trend towards the private sector's growing participation in training healthcare professionals, influenced by public policies. In Brazil, private medical schools have developed and expanded with government financing, more recently with support from the More Doctors Program. The study aimed to describe and analyze movements in the corporate reconfiguration of the educational sector, with trends towards oligopolization and financialization related to the recent expansion of medical education in Brazil. An exploratory qualitative and quantitative approach was used, associated with various methodological strategies, to overcome the limitations in access to information, with data collection from open-access secondary databases. The private sector now accounts for 60% of the course supply and 69% of enrollment in medicine, 31% of which is supplied by ten educational groups. The groups studied here highlight the dynamic educational market, mechanisms of financialization and concentration, and formation of an oligopoly in the supply of higher education, particularly in medical training. There has been a trend towards concentration of the supply of institutions of higher learning since 2000. The largest groups employ similar management strategies, expansion of their market share, shareholder format, business diversification, and uptake of investors and financial capital. Government programs like the More Doctors Program helped expand and concentrate the private educational sector with government transfers or advance financing. The trend has been towards oligopolization and financialization.

Tendencia global de aumento de la participación del sector privado en la formación de profesionales de salud, fuertemente influenciada por políticas públicas. En Brasil, los cursos médicos privados se desarrollaron y expandieron con la financiación gubernamental y, recientemente, con el apoyo del Programa Más Médicos. El objetivo fue describir y analizar los movimientos de reconfiguración empresarial del sector educacional con tendencias de oligopolización y financiarización, relacionados con la expansión reciente de la enseñanza médica en Brasil. Abordaje cualicuantitativo, exploratorio y descriptivo, asociado a varias estrategias metodológicas, con el fin de superar las limitaciones de acceso a la información, con recogida de datos en bases secundarias de acceso público. El sector privado es responsable de la oferta de un 60% de los cursos y de un 69% de las plazas de medicina, de las cuales cerca de un 31% se ofertan por parte de diez grupos educacionales. En los grupos estudiados se destacan: dinamicidad del mercado educacional; mecanismos de financiarización y concentración; formación de oligopolio en la oferta de enseñanza superior, en particular de la formación médica. Tendencia de concentración de la oferta en instituciones de educación superior privados desde el año 2000. Similitud de los mayores grupos en las estrategias de gestión, ampliación de la participación en el mercado, conformación del esquema de socios, diversificación de los negocios, así como la captación de inversores y capital financiero. Programas gubernamentales, como el Programa Más Médicos, contribuyeron a la expansión y tendencia de concentración del sector educacional privado con la transferencia de recursos públicos o anticipación de los mismos. Tendencia a la oligopolización y la financiarización.

Assessment of human resources for health programme implementation in 15 Latin American and Caribbean countries.

BACKGROUND: The health systems in the Americas region are characterized by fragmentation and segmentation, which constitute an important barrier to expanding coverage, achieving integrated primary health care, and reducing inefficiency and discontinuity of care. An assessment of the human resources for health (HRH) programmes that have been implemented at the country level was developed as part of the measurement of the 20 HRH regional goals for 2007-2015, adopted in 2007 by the Pan American Sanitary Conference (CSPA). METHODS: The exercise was a combination of academic research and the development/application of an advocacy tool involving policy makers and stakeholders to influence the decision-making in the development, implementation, or change of HRH programmes while building evidence through a structured approach based on qualitative and quantitative information and the exchange and dissemination of best practices. RESULTS: This paper covers the methodological challenges, as well as a summary of the main findings of the study, which included 15 countries: Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua and Panama in the Central America, Dominican Republic in the Caribbean, Chile, Colombia, Ecuador and Peru in the Andean sub region, and Argentina, Paraguay, and Uruguay in the South Cone. Despite the different contexts, the results showed that the programmes evaluated faced common challenges, such as lack of political support and financial unsustainability. CONCLUSIONS: The evaluation process allowed the exchange and dissemination of practices, interventions, and programmes currently running in the region. A shared lesson was the importance of careful planning of the implementation of programmes and interventions. The similarities in the problems and challenges of HRH among the participating countries highlighted the need for a cooperation programme on the evaluation and assessment of implementation strategies in the Americas region.

Assessment of human resources for health programme implementation in 15 Latin American and Caribbean countries

Background: The health systems in the Americas region are characterized by fragmentation and segmentation, which constitute an important barrier to expanding coverage, achieving integrated primary health care, and reducing inefficiency and discontinuity of care. An assessment of the human resources for health (HRH) programmes that have been implemented at the country level was developed as part of the measurement of the 20 HRH regional goals for 2007­2015, adopted in 2007 by the Pan American Sanitary Conference (CSPA). Methods: The exercise was a combination of academic research and the development/application of an advocacy tool involving policy makers and stakeholders to influence the decision-making in the development, implementation, or change of HRH programmes while building evidence through a structured approach based on qualitative and quantitative information and the exchange and dissemination of best practices. Results: This paper covers the methodological challenges, as well as a summary of the main findings of the study, which included 15 countries: Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua and Panama in the Central America, Dominican Republic in the Caribbean, Chile, Colombia, Ecuador and Peru in the Andean sub region, and Argentina, Paraguay, and Uruguay in the South Cone. Despite the different contexts, the results showed that the programmes evaluated faced common challenges, such as lack of political support and financial unsustainability. Conclusions: The evaluation process allowed the exchange and dissemination of practices, interventions, and programmes currently running in the region. A shared lesson was the importance of careful planning of the implementation of programmes and interventions. The similarities in the problems and challenges of HRH among the participating countries highlighted the need for a cooperation programme on the evaluation and assessment of implementation strategies in the Americas region.(AU)

Tratamento da infecção pelo vírus da hepatite C em candidatos a transplante renal submetidos a diálise: impacto orçamentário no SUS / Hepatitis C treatment in patients on dialysis awaiting renal transplantation: a budget impact analysis

Trata-se de uma análise de impacto orçamentário derivada dos resultados do estudo "Custo-efetividade do tratamento da infecção pelo vírus da hepatite C em candidatos a transplante renal submetidos a diálise". Teve como objetivo estimar o impacto orçamentário da ampliação da oferta do tratamento da infecção pelo vírus da hepatite C (VHC) para candidatos a transplante renal. Para tal, foi construído um modelo de Markov, a fim de estimar o custo médio do tratamento de diferentes proporções da população-alvo. Foram estimados os casos prevalentes e incidentes da infecção na população em diálise, candidata a transplante renal, em um horizonte de tempo de dez anos. Com base nestas estimativas, foi calculado o valor a ser despendido pelo SUS para tratar a população-alvo em três cenários diferenciados, caracterizados pela proporção da população submetida ao tratamento. Os valores encontrados foram comparados com o gasto do sistema para garantia de terapias de substituição renal no período de um ano, identificando-se que o custo do tratamento de toda a população candidata a transplante, infectada pelo VHC, corresponde a 0,3 por cento do valor despendido com TRS pelo SUS.

This is an analyses of the budget impact derived from the cost-effectiveness study on the hepatitis C treatment in candidates for renal transplantation under dialysis. It aims to estimate the budget impact of an offer of hepatitis C treatment for all candidates for renal transplantation. A Markov model was developed to estimate the mean cost for treatment of distinct proportions of the target population. The prevalence and incidence of hepatitis C in the candidates for renal transplantation in the dialysis population was also estimated in a horizon of ten years. Based on these estimative, we calculate the amount needed for treatment of this population in three distinct scenarios characterized by a proportion of the population under treatment. The values were compared with the expense of the system to guarantee renal replacement therapies in one year, identifying the cost of treatment of all candidates for transplant, infected with HCV, corresponding to 0.3 percent of the amount spent with renal transplantation within the SUS.

A public policy approach to local models of HIV/AIDS control in Brazil.

OBJECTIVES: We investigated involvement and cooperation patterns of local Brazilian AIDS program actors and the consequences of these patterns for program implementation and sustainability. METHODS: We performed a public policy analysis (documentary analysis, direct observation, semistructured interviews of health service and nongovernmental organization [NGO] actors) in 5 towns in 2 states, São Paulo and Pará. RESULTS: Patterns suggested 3 models. In model 1, local government, NGOs, and primary health care services were involved in AIDS programs with satisfactory response to new epidemiological trends but a risk that HIV/AIDS would become low priority. In model 2, mainly because of NGO activism, HIV/AIDS remained an exceptional issue, with limited responses to new epidemiological trends and program sustainability undermined by political instability. In model 3, involvement of public agencies and NGOs was limited, with inadequate response to epidemiological trends and poor mobilization threatening program sustainability. CONCLUSIONS: Within a common national AIDS policy framework, the degree of involvement and cooperation between public and NGO actors deeply impacts population coverage and program sustainability. Specific processes are required to maintain actor mobilization without isolating AIDS programs.

Assimetria nas relações internacionais, propriedade industrial e medicamentos anti-aids / Asymmetry in international relations, industrial property rights and anti-HIV medication

Este artigo analisa a assimetria nas relações internacionais entre países no que diz respeito ao reconhecimento da propriedade industrial no setor específico da indústria farmacêutica. O foco é o impacto destas relações no acesso a medicamentos anti-retrovirais (ARV), questão de interesse mundial em face da sua relação com o desenvolvimento das nações. A disputa de interesses no campo e o posicionamento de alguns países frente às leis patentárias, ao longo do tempo, apontam um cenário pouco favorável para acesso aos medicamentos anti-aids pelos países que não pertencem ao núcleo do sistema mundial. O sucesso do programa brasileiro de Doenças Sexualmente Transmissíveis (DSTs) e Aids nas negociações dos preços dos ARV, ao contrário, aponta para novas possibilidades de enfrentamento desta realidade. A saída parece ser o fortalecimento interno dos Estados Nacionais e um papel ativo das Agências do Sistema das Nações Unidas na defesa dos interesses humanos coletivos.

This paper analyzes the asymmetry in the international relations as refers to the recognition of industrial property rights in the pharmaceutical industry. It focuses on the impact of such relations upon the access to ARV medication, an issue of worldwide interest due to its connection with the development of the nations. Clashing interests and the position taken by some countries in their patent laws point to a scenario less favorable for the access of peripheral countries to anti-HIV/AIDS medication. On the other hand, it seems that the success of the Brazilian STD/AIDS program in negotiating ARV prices will open new possibilities. The solution may be the internal strengthening of the National States and the active role played by the Agencies of the United Nations System in defense of the collective human interests.

[Asymmetry in international relations, industrial property rights and anti-HIV medication]. / Assimetria nas relações internacionais, propriedade industrial e medicamentos anti-aids.

This paper analyzes the asymmetry in the international relations as refers to the recognition of industrial property rights in the pharmaceutical industry. It focuses on the impact of such relations upon the access to ARV medication, an issue of worldwide interest due to its connection with the development of the nations. Clashing interests and the position taken by some countries in their patent laws point to a scenario less favorable for the access of peripheral countries to anti-HIV/AIDS medication. On the other hand, it seems that the success of the Brazilian STD/AIDS program in negotiating ARV prices will open new possibilities. The solution may be the internal strengthening of the National States and the active role played by the Agencies of the United Nations System in defense of the collective human interests.

A vulnerabilidade da vida com HIV/AIDS / Vulnerability of life with HIV/Aids

Esta tese pretende contribuir para o desenvolvimento de respostas públicas rumo à diminuição do impacto do HIV/Aids nos campos, econômico, político e social tanto no nível coletivo quanto no individual. Discute aspectos téorico-conceituais das noções de risco e vulnerabilidade, mostrando que a atual aplicação e apropriação dessas noções na resposta à essa epidemia dificulta o reconhecimento dos problemas adicionais enfrentados após o diagnóstico. Apresenta as diversas formas de pobreza, desigualdade e exclusão a partir dos indicadores sociais comumente usados e respectivas lógicas construtivas. Questiona as afirmações recentes sobre a queda da desigualdade, da pobreza e da indigência no país; e considera que a desigualdade e a exclusão que afetam a população em geral é a mesma a afetar pessoas que vivem com HIV/Aids. Porém, aponta a existência de vulnerabilidade potencial, conceito desenvolvido nesta tese, na ausência de rede de suporte social. Para identificar e inferir sobre o que ocorre nas vidas das pessoas que vivem em situação de desigualdade ou exclusão após a infecção pelo HIV utiliza dados coletados em pesquisa de survey, discursos, estórias e memórias de casos reais da prática profissional desta autora. O objetivo desta tese é demonstrar que o conceito de vulnerabilidade aplicado após o diagnóstico é importante ferramenta para reconhecer e intervir sobre as dificuldades e problemas adicionais enfrentados. Ressalta a evolução da resposta brasileira à essa epidemia e demonstra as lacunas existentes como desafios a seu aperfeiçoamento. Conclui que o reconhecimento dos problemas adicionais após o diagnóstico e o uso do conceito de vulnerabilidade potencial abre novas possibilidades de enfrentamento do HIV/Aids e exige respostas públicas interligadas e intersetoriais.

This thesis aims to contribute to the development of public responses geared towards the reduction of the impact of HIV/Aids in economic, political and social terms, as well as at the individual level. It discusses theoretic and conceptual aspects of different notions ofrisk and vulnerability, showing that the current application of such notions to the response to that epidemic makes it difficult to acknowledge the additional problems faced after the diagnosis is made. It presents the different forms of poverty, inequality and exclusion taking the social indicators usually employed and their respective constructive logics as a starting point. It brings into question the recent statements made on the decline of inequality, poverty and indigence in the country; and it considers that the inequality andexclusion faced by the population in general is the same that affects the people who live with HIV/Aids. It points out, though, to the presence of a potentiation of vulnerability in this group, in the absence of a social protection network. In order to identify an infer about what happens in the lives of the people who live in a situation of inequality or exclusion after the HIV infection the thesis uses data collected in a survey, discourses, stories andmemories of real cases of the professional practice of the author. The goal of this thesis is to demonstrate that the concept of vulnerability applied after the diagnosis is an important tool to acknowledge and intervene on the additional difficulties and problems that are faced by people in that situation. The thesis stresses the evolution of the Brazilian response to that epidemic and demonstrates its existing gaps as challenges to its improvement. Itfinally concludes that acknowledging the problems faced after diagnosis and the utilization of the concept of potential vulnerability opens new possibilities to the fight against HIV/Aids and demands interconnected and intersectorial responses.