Abstract
Since 2017, the Brazilian health system is facing a wave of counter-reforms in policies that have expanded coverage and access and intended to change the care model. Primary Health Care (PHC) has been substantially modified by synergistic and complementary federal official acts. The creation of federal autonomous social service for the provision of doctors; public consultation to institute basket of consumption in healthcare; the flexibility of the weekly workload of doctors and nurses, who may integrate more than one team; the non-setting of a minimum number of community health workers per team form the context in which the Previne Brasil Program was launched to be in force by 2020. The government's argument is to increase: flexibility and local autonomy to organize services, greater efficiency and valorization. of performance. Criticism from sanitarians, some state councils of municipal authorities and the National Health Council points to the privatizing, marketing, selective and focused character of the proposal that is moving towards universal health coverage. This paper analyzes the Previne Brazil Program which, among other things, alters funding and suggests increasing resources for PHC in a context of freezing social spending. Contradictions and alternatives are identified to minimize potential damage to existing policies.
Highlights
Resumo Desde 2017, o sistema de saúde brasileiro enfrenta uma onda de contrarreformas em políticas que ampliaram cobertura e acesso e pretenderam mudar o modelo assistencial
Since 2017, the Brazilian health system is facing a wave of counter-reforms in policies that have expanded coverage and access and intended to change the care model
The creation of federal autonomous social service for the provision of doctors; public consultation to institute basket of consumption in healthcare; the flexibility of the weekly workload of doctors and nurses, who may integrate more than one team; the non-setting of a minimum number of community health workers per team form the context in which the Previne Brasil Program was launched to be in force by 2020
Summary
A nova proposta de financiamento da APS foi divulgada em seminários realizados em vários estados, com a participação do Secretário de Atenção Primária, Erno Harzheim, de conselhos de secretários estaduais e municipais de saúde, gestores locais e representantes do movimento sanitarista. Harzheim baseou-se em duas críticas ao modelo vigente: i) Suposta “ineficiência” dos serviços em APS, considerando o grande número de usuários do SUS não cadastrados pelas equipes. Dos 50 milhões não cadastrados, 30 milhões seriam beneficiários de programas sociais, em situação de maior vulnerabilidade; ii) Baixa valorização do componente de desempenho das equipes, tendo em vista serem as transferências federais aos entes subnacionais majoritariamente calculadas com base em critérios populacionais. O modelo ora proposto romperia com essa lógica a partir do incremento, em valores nominais, de aproximadamente dois bilhões de reais ao orçamento para a APS em 2020, com novos critérios fundamentados em três eixos: i) Substituição dos Pisos de Atenção Básica (PAB) Fixo e Variável pela Capitação Ponderada. Iii) Repasses vinculados a ações e programas de saúde contidos no PAB variável, passarão a compor o eixo de adesão a programas estratégicos, como os Programas Saúde na Hora; Apoio à Informatização e Qualificação dos Dados da APS - Informatiza APS e Programa de Formação em Residência Médica ou Multiprofissional em Odontologia e Enfermagem na Saúde da Família
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