Reforma do Estado e reforma de sistemas de saúde: experiências internacionais e tendências de mudan?a

摘要

This text discusses the agenda for reform of the State, assessing the central themes and the difficulties facing implementation; it identifies the forms it takes in models being implemented in the area of health care and analyzes some countries' reforms (USA, United Kingdom and Colombia). It also points to approaches emerging as trends in proposals for sector reform in Brazil, vis a vis the international experience, where the idea of split between financing and provision functions has been flourished, and that introducing competition mechanisms into resource allocation has been hardly criticized. Although beginning from far more precarious conditions, Latin American reforms have been more radical and accompanied by extreme financial constraints, with substantial under-funding of the sector. One trend in the region is towards the increasing likelihood of previous systems being dismantled with no guarantee of substantive improvements in coverage or equity, either because of the radicalism of the processes, or because of the high degree of experimentation with which reforms are being implemented.