Dos clamores das ruas aos rumores no Congresso: uma análise da conjuntura recente da saúde no Brasil / The popular claim and Congress rumors: a recent conjuncture analysis of health in Brazil / De las voces de las calles a los rumores en el Congreso: un análisis de lacoyuntura reciente de salud en Brasil

O processo da Reforma Sanitária Brasileira requer acompanhamento da Política de Saúde. Assim, objetivou-se analisar a conjuntura e as políticas de saúde no Brasil no período de junho/2013 a março/2015. A investigação utilizou pesquisa documental por meio da mídia, programas de candidaturas à presidência e publicações de entidades de saúde para identificar fatos e acontecimentos relevantes a serem categorizados e analisados. Em junho de 2013, a saúde foi apontada como prioridade pelas manifestações de rua, obtendo como resposta institucional o Programa Mais Médicos. Entretanto, a Reforma Sanitária e o SUS não prevaleceram no debate eleitoral das campanhas à presidência, enquanto predominava a influência do setor privado. Aprovações de leis recentes no Congresso Nacional podem indicar assimilação da lógica de Cobertura Universal. Mudanças na política econômica e prioridades governamentais sugerem desmonte das conquistas sociais e apontam a necessidade de rearticulação da sociedade civil em defesa do direito universal à saúde...

The Brazilian Health Reform's process needs the continuous monitoring of the Health Policy. So, theobjective was to analyze the conjuncture and health policies in Brazil from June/2013 to March/2015. Thestudy used documental research through the media, government programs of the presidential candidatesand health associations' documents to identify the relevant facts and events for analysis. In June/2013,health was identified as a priority by protests, getting as government response the More Doctors Program.However, the Brazilian Health Reform and the SUS did not preponderate in the electoral debate of thepresidency running, while the private sector had predominant influence. Laws recently passed in Congressmay indicate assimilation of Universal Coverage logic. Changes in economic policy and governmentpriorities suggest regression of social rights and the need for re-articulation of civil society in defense of theuniversal right to health...

El proceso de la Reforma de Salud Brasileña requiere un seguimiento de la política de salud. El objetivofue analizar la coyuntura y las políticas de salud en Brasil, de junio/2013 a marzo/2015. Fue utilizadala investigación documental a través de los medios de comunicación, programas de los candidatos a laPresidencia y publicaciones de las entidades de salud para identificar acontecimientos relevantes paraanálisis. En junio de 2013 la salud fue una prioridad para las manifestaciones, obteniendo como respuestadel gobierno lo Programa Más Médicos. Pero, la Reforma de Salud Brasileña y el SUS no prevalecieron en eldebate electoral de la campaña presidencial, donde el sector privado consiguió la influencia predominante.Recientes leyes aprobadas en el Congreso pueden indicar asimilación de la lógica de la Cobertura Universal.Los cambios en la política económica y prioridades del gobierno sugieren desmantelamiento de lasconquistas sociales y destacan la necesidad de re-articulación de la sociedad civil en defensa del derechouniversal a la salud...

Democracia sem equidade: um balanço da reforma sanitária e dos dezenove anos de implantação do Sistema Único de Saúde no Brasil / Democracy without equity: analysis of health reform and nineteen years of National Health System in Brazil

Este artigo procura avaliar os dezenove anos da implementação do Sistema Único de Saúde (SUS) no Brasil sob o prisma da equidade. Toma como ponto de partida um contexto de expectativas vigentes nos anos oitenta do século XX de que a democratização do país e do setor saúde pudesse, por si, levar a uma situação mais equitativa em relação ao acesso a serviços de saúde. Discute os conceitos de democracia e equidade, analisando que situações podem facilitar ou dificultar sua associação no plano teórico, aplicando-os ao contexto brasileiro de forma mais geral e aos movimentos pela reforma sanitária e implementação do SUS em particular. Procura também evidenciar os limites e as possibilidades destes movimentos no que tange à redução das desigualdades no acesso a serviços de saúde que ainda persistem. A conclusão aponta a necessidade de que se estabeleçam outros movimentos que busquem a redução destas e de outras desigualdades, como o acesso á educação, moradia, etc., chamando a atenção, em especial, para o papel do Estado, que é questionado em sua pretensa debilidade para promover justiça social, uma vez que se mostra muito potente quando aborda outras questões.

This paper aims to evaluate the nineteen years of the National Health System in Brazil, under the prism of equity. It takes into account the current political context in Brazil in the 80s, that the democratization of the country and the health sector could, per se, lead to a more equitable situation regarding the access to health services. Democracy and equity concepts are here discussed; analyzing which situations may facilitate or make it difficult its association in a theoretical plan, applying them to the Brazilian context in a more general form and, to emphasizing practical implications to the National Health System and to groups of activism related to health reforms. It also seeks to show the limits and possibilities of these groups with regards to the reduction of inequality, in relation to the access to health services, which still remain. To conclude, the author points out the need for other movements to be established which seek the reduction of such and other inequalities, such as access to education, housing, etc, drawing special attention to the role played by the State, which is questioned regarding its incapacity of promoting equity, once it presents itself as being powerful when approaching other matters.

Reforma integral para mejorar el desempeño del sistema de salud en México / Comprehensive reform to improve health system performance in Mexico

A pesar de haber alcanzado una esperanza de vida promedio de 75 años, similar a la de países más desarrollados, México ingresó al siglo XXI con un sistema de salud marcado por su incapacidad para ofrecer protección financiera en salud a más de la mitad de su población. Esto es resultado y causa de las desigualdades sociales que han caracterizado el proceso de desarrollo en México. Varias limitaciones estructurales han dificultado el funcionamiento y limitado el avance de su sistema de salud. Consciente de que la falta de protección financiera era su principal debilidad, México ha emprendido una reforma estructural para mejorar el desempeño del sistema de salud mediante el establecimiento del Sistema de Protección Social en Salud (SPSS), el cual ha introducido nuevas reglas de financiamiento e incentivos. La principal innovación de la reforma ha sido el Seguro Popular de Salud, el componente de aseguramiento del SPSS dirigido al financiamiento de la atención médica para todas aquellas familias, en su mayoría pobres, que históricamente habían sido excluidas de la seguridad social. La reforma ha permitido un incremento significativo en la inversión pública en salud, al tiempo que realinea los incentivos para garantizar una atención de mayor calidad técnica e interpersonal. En este trabajo se describen las principales características y los resultados iniciales de este esfuerzo de reforma de México, y se derivan algunas lecciones para otros países que consideren llevar a cabo transformaciones a su sistema de salud en circunstancias de desafío similares.

Despite having achieved an average life expectancy of 75 years, much the same as that of more developed countries, Mexico entered the 21st century with a health system mared by its failure to offer financial protection in health to more than half of its citizens; this was both a result and a cause of the social inequalities that have marked the development process in Mexico. Several structural limitations have hampered performance and limited the progress of the health system. Conscious that the lack of financial protection was the major bottleneck, Mexico has embarked on a structural reform to improve health system performance by establishing the System of Social Protection in Health (SSPH), which has introduced new financial rules and incentives. The main innovation of the reform has been the Seguro Popular (Popular Health Insurance), the insurance-based component of the SSPH, aimed at funding health care for all those families, most of them poor, who had been previously excluded from social health insurance. The reform has allowed for a substantial increase in public investment in health while realigning incentives towards better technical and interpersonal quality. This paper describes the main features and initial results of the Mexican reform effort, and derives lessons for other countries considering health-system transformations under similarly challenging circumstances.

Impacto de la reforma del sistema de seguridad social sobre la equidad en los servicios de salud en Colombia / The impact of social security system reform on health services equity in Colombia

To evaluate the impact on access to, and use of, health services in Colombia's new national health insurance system, the authors compared two cross sections of the population: before (1993) and after (1997), with the approval of Act 100, creating the General System for Social Security in Health (SGSSS). Two equity indicators were assessed: concentration curves (CC) and concentration indices (CI), summarizing the distribution of access to health care and utilization of health care services provided by the SGSSS according to income deciles. Between 1993 and 1997, the CI for access to insurance halved from 0.34 to 0.17; simultaneously, coverage increased from 23 to 57, especially among the poorest segments of the population, where it increased from 3.7 to 43.7 as a result of subsidies provided by local governments. The CI for utilization of health care services did not vary significantly. Increased disease prevalence and utilization of services among the insured, due to biased selection of risks and moral hazards, were also documented. These findings suggest a positive impact by the Reform on inequalities in access to health care insurance; however, a similar effect on inequities in utilization of health services is not clear.

Política regional de salud y reforma sectorial / Regional politics of health and sectorial reform

Se presenta la experiencia desarrollada por la Región de Salud Inka en la generación e implementación de una política regional de salud en el marco de la actual reforma sectorial