[Governance and regulation in health: challenges for health management in Greater Metropolitan São Paulo, Brazil].
This paper discusses the relationship between the public and private sectors in the Unified National Health System (SUS), based on research whose objective was to identify governance strategies and mechanisms for public/private relations in the health sector, considering the search for equity in Greater Metropolitan Sao Paulo, Brazil. Governance was used as an analytical category, with health system regulation as the issue. Municipal and State health secretaries, members of health councils, and SUS staff were interviewed, and the empirical material was classified as: (a) regulatory mechanisms and instruments; (b) power loci; and (c) actors' positions concerning the SUS and its relationship to the private sector. Mechanisms and instruments have been created and used in the municipalities for regulation of their own services. Regulatory measures for the complementary and supplementary healthcare sector are practically nonexistent. There are numerous institutional power loci, seen more as places for submitting demands than as forums for negotiation. Despite some progress, governance appears to be more of a formal issue. Discussion is needed on the relationship between the public and private sectors and its regulation by municipalities in order to improve the health system.
Ibanhes
Lauro Cesar
LC
Secretaria de Estado da Saúde de São Paulo, Instituto de Saúde, Rua Santo Antonio 590, São Paulo, SP 01314-000, Brazil. nisis@isaude.sp.gov.br
Heimann
Luiza Sterman
LS
Junqueira
Virginia
V
Boaretto
Roberta Cristina
RC
Pessoto
Umberto Catarino
UC
Cortizo
Carlos Tato
CT
Castro
Iracema Ester do Nascimento
IE
Rocha
Jucilene Leite da
JL
Kayano
Jorge
J
Luiz
Olinda do Carmo
Odo C
Barboza
Renato
R
Telesi
Emilio
E
D001938:Brazil; D003695:Delivery of Health Care / Q000458:organization & administration*; D006285:Health Planning; D006293:Health Promotion; D006801:Humans; D009313:National Health Programs / Q000458:organization & administration*; D017149:Private Sector / Q000458:organization & administration*; D011640:Public Policy; D017150:Public Sector / Q000458:organization & administration*; D012926:Social Control, Formal; D012943:Social Security; D014505:Urban Population