Os modelos de reforma sanitária dos anos 80: uma análise crítica

Abstract

This article analyses the main sanitary reform models in the central countries dissecting the body of ideas that framed the strategies of change and the constituent elements of a new post-welfare agenda also for the health sector. It takes the premise that the fiscal crises of the state as of mid 70' together with the decade's neoliberal hegemony contributed to the formulation of both a common sectorial diagnosis and prescriptions that were disseminated as alternatives for the control of sanitary expenditure increase control and for the functioning of more efficient consumer geared health services. The re-introduction of competition in the health area based on the North-American experience had various re-readings and applications in the European context. In this process some models considered paradigmatic for the necessary re-constructing of health services were created. These were linked to both the macro-economic cost reduction and public deficit growth control demands. The comparative evaluation of such policies in the central countries ascertains that the national options varied a lot and that there is a great distance between the ideological discourse and the implemented policies. It is evident that there is a more central and regulatory state action beside the clear tension between the political and financial controls and the operationalisation of the competition mechanism in the health system.