Abstract
BackgroundThis study analyzed several political determinants of increased private-sector management in Brazilian health care. In Brazil, the poor depend almost exclusively on the public Unified Health System (the SUS), which remains severely underfunded. Given the overhead costs associated with privately contracted health services, increased private management is one driver of higher expenditures in the system. Although left parties campaign most vocally in support of greater public control of the SUS, the extent to which their stated positions translate into health care policy remains untested.MethodsDrawing on multiple publicly available data sources, we used linear regression to analyze how political party-in-power and existing private sector health care contracting affect the share of privately managed health care services and outsourcing in municipalities. Data from two election periods—2004 to 2008 and 2008 to 2012—were analyzed.ResultsOur findings showed that although private sector contracting varies greatly across municipalities, this variation is not systematically associated with political party in power. This suggests that electoral politics plays a relatively minor role in municipal-level health care administration. Existing levels of private sector management appear to have a greater effect on the public-private makeup of the Brazilian healthcare system, suggesting a strong role of path dependence in the evolution of Brazilian health care delivery.ConclusionDespite campaign rhetoric asserting distinct positions on privatization in the SUS, factors other than political party in power have a greater effect on private-sector health system management at the municipal-level in Brazil. Given the limited effect of elections on this issue, strengthening participatory bodies such as municipal health councils may better enfranchise citizens in the fundamental debate over public and private roles in the health care sector.
Highlights
This study analyzed several political determinants of increased private-sector management in Brazilian health care
Descriptive statistics In aggregate, there was an increase in privately managed equipment of all types between 2006 and 2012 in Brazil (Figure 1)
In Brazil, where left-leaning politicians make frequent claims to preserve the public nature and accessibility of the health care system, municipal governments were not associated with significant partisan behavior in private sector contracting in health care between 2004 and 2012
Summary
This study analyzed several political determinants of increased private-sector management in Brazilian health care. Left parties campaign most vocally in support of greater public control of the SUS, the extent to which their stated positions translate into health care policy remains untested. A vocal left argued that the proliferation of private sector stakeholders alongside public sector provision was driving up overhead costs and complicating the structure of Brazilian healthcare delivery. This study examined whether and how political party in power influences public-private contracts in health care delivery in Brazil. We compared whether municipal election results, or existing health system characteristics, played a greater role in determining the extent of private sector involvement in health care provision. Brazil’s health system is a decentralized, two- part public-private system that grants access to care to the poor and the wealthy
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