Crítica a modelos de avaliação de desempenho de sistemas de saúde

Abstract

Introduction – In health, the logic of new public considers the health services as non-state activities. Thus, the role of 'control' reaches the centrality of discussion which the control happens with the state's position on the over their 'executing agencies', in another hand, the civil society controls the state through monitoring of the of state actions. Under this scenario, the management by health performance has defended the idea of using 'performance evaluation models' to measure (and compare) the results from work carried out in health systems as well as serve as an instrument of monitoring of public administration by civil society. Objective – Therefore, the aim of this research was to develop a critic of evaluation models of health systems deconstructing its ideological content as much as external and internal state control tool, taking as empirical basis the experience of Performance Index of Unified Health System (PIUHS). Method – For this, we used three different methodological moments. Firstly, it was used a narrative review described by Rothers to conduct a critical review on the subject; secondly, it was used the systematic review of literature on the topic 'evaluation of health system performance' making it compatible with a qualitative meta-synthesis of type 'metassumarization'; and thirdly, it was used a qualiquantitative methodology, which raised the speeches was made in electronic sites, portals, blogs and web blogs that focused on this Performance Index. It used the Collective Subject Discourse method as a form of analysis beyond the concepts of 'individuation' in Touraine and 'civil society' in Gramsci as an interpretative support of the object under investigation. Results – In the narrative review, the focus was on how the direct contracting results have been expressed in the of health systems evaluations. Counter-argument was reinforced attention to the complexity of the field from the point of view of the intense disagreement on key terms as well as the methodological problems in the study of health systems. In metassumarization, the total number of articles (n = 32), 23 articles (71.8%) did not have a definition of performance. Among the most frequent subsidiary concepts that make up the idea is the concept of 'efficiency'