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BMC Health Services Research
Published in: BMC Health Services Research 1/2017

Open Access 01-12-2017 | Research article

Do elections matter for private-sector healthcare management in Brazil? An analysis of municipal health policy

Authors: Alecia J. McGregor, Carlos Eduardo Siqueira, Alan M. Zaslavsky, Robert J. Blendon

Published in: BMC Health Services Research | Issue 1/2017

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Abstract

Background

This study analyzed several political determinants of increased private-sector management in Brazilian health care. In Brazil, the poor depend almost exclusively on the public Unified Health System (the SUS), which remains severely underfunded. Given the overhead costs associated with privately contracted health services, increased private management is one driver of higher expenditures in the system. Although left parties campaign most vocally in support of greater public control of the SUS, the extent to which their stated positions translate into health care policy remains untested.

Methods

Drawing on multiple publicly available data sources, we used linear regression to analyze how political party-in-power and existing private sector health care contracting affect the share of privately managed health care services and outsourcing in municipalities. Data from two election periods—2004 to 2008 and 2008 to 2012—were analyzed.

Results

Our findings showed that although private sector contracting varies greatly across municipalities, this variation is not systematically associated with political party in power. This suggests that electoral politics plays a relatively minor role in municipal-level health care administration. Existing levels of private sector management appear to have a greater effect on the public-private makeup of the Brazilian healthcare system, suggesting a strong role of path dependence in the evolution of Brazilian health care delivery.

Conclusion

Despite campaign rhetoric asserting distinct positions on privatization in the SUS, factors other than political party in power have a greater effect on private-sector health system management at the municipal-level in Brazil. Given the limited effect of elections on this issue, strengthening participatory bodies such as municipal health councils may better enfranchise citizens in the fundamental debate over public and private roles in the health care sector.
Footnotes
1
According to a 2012 analysis by the Center of Public Policies of Insper (Instituto de Ensino e Pesquisa) entitled “O Panorama da Saúde do Brasil,” (The Health Panorama in Brazil) 87% of the poorest quintile of the Brazilian population used a public establishment (with 86% using a SUS establishment) in their last visit, compared to only 23% of the richest Brazilians (20% using the SUS) [53].
 
2
Throughout this paper, we use the concepts privatization, private sector involvement in the health system, and privately managed health care/services almost interchangeably. However, it should be noted that “privatization” is the broadest concept, which includes “private sector involvement in the health system,” and “privately managed health services” is, in turn, one type of private sector involvement.
 
3
The widespread availability of dental equipment is in part due to the 2004 implementation of the Brasil Sorridente (Brazil Smiling) program, the current National Dental Health Policy initiated to improve dental health in Brazil.
 
4
Recent figures show that the dental equipment sector is the most successful of all Brazilian medical device manufacturers. Although Brazil is the largest medical equipment market in Latin America, the majority of medical technology is imported. However, the dental equipment sector is the only device manufacturer that has seen a foreign trade surplus [54].
 
5
During the 2012 mayoral elections in São Paulo, the PT candidate Fernando Haddad accused the PSDB Candidate José Serra of having privatization “running through his veins” and of intending to privatize 25% of SUS beds [28].
 
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Metadata
Title
Do elections matter for private-sector healthcare management in Brazil? An analysis of municipal health policy
Authors
Alecia J. McGregor
Carlos Eduardo Siqueira
Alan M. Zaslavsky
Robert J. Blendon
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2017
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-017-2427-5

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