O desafio da participação cidadã nos sistemas de saúde do Sul da Europa: uma revisão da literatura

Ana Raquel Matos,Mauro Serapioni

doi:10.1590/0102-311x00066716

Abstract

The current article analyzes existing mechanisms for public participation in health systems in the countries of Southern Europe. Results are presented from a literature review focusing on public participation in health systems, highlighting the potentialities and challenges emerging from the principal national experiences in the respective countries: Spain, Greece, Italy, and Portugal. The article begins by characterizing the health systems, then presents the methodology followed by the results of the analysis in each country, emphasizing the different forms of participation, both institutionalized and non-institutionalized. The study's principal conclusion is that a legislative discourse has prevailed, which in most cases has not materialized in actual participatory practices; meanwhile, non-institutionalized forms of participation have emerged with a special leading role in the health area, featuring protests, largely spurred by the current economic crisis.

Highlights

For more than 20 years, approaches that prioritize participation in decision-making processes based on different possibilities for citizens’ participation have been discussed as central to democratization
No common definition exists for the terms “public participation”, “citizens’ participation”, and “users’ or patients’ involvement” in this article, they are used to refer to direct involvement by the population in decisions on public health planning and organization
The term “patient” refers to users of health services, those who can speak with the authority that comes from experience with the service 5, while the term “citizen” refers to all persons that have the right to receive health care from the state

Summary

Introduction

For more than 20 years, approaches that prioritize participation in decision-making processes based on different possibilities for citizens’ participation have been discussed as central to democratization. The results achieved far are still quite modest, because not all citizens have the same means and/or the adequate means to exercise the right to participate in decision-making processes in health. In this context, citizens’ participation was formally established as a right during the Conference of Alma-Ata 7, the International Conference on Primary Health Care, organized by the World Health Organization (WHO), in 1978. Based on the social welfare model designed by Esping-Andersen 15 and later improved by Ferrera 16, it is possible to identify four major European regions, including their health systems:

CITIZENS’ PARTICIPATION IN HEALTH SYSTEMS IN SOUTHERN EUROPE

Methodology

Findings

Conclusions