The struggle over a national health care system: the movimento sanitário and health policy-making in Brazil, 1960 - 1990 = De strijd om een nationaal gezondheidszorgsysteem
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| Format: | Thesis Book |
| Language: | English |
| Published: |
1996
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| Subjects: | |
| Online Access: | Inhaltsverzeichnis |
| Physical Description: | XX, 301 S. |
| ISBN: | 9039310734 |
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MARC
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| 245 | 1 | 0 | |a The struggle over a national health care system |b the movimento sanitário and health policy-making in Brazil, 1960 - 1990 = De strijd om een nationaal gezondheidszorgsysteem |c door Cornelis Johannes van Stralen |
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Record in the Search Index
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| adam_text | CONTENTS
Tables ix
Boxes xi
Acronyms xiii
Acknowledgments xix
INTRODUCTION . 1
1. THE OLD REPUBLIC: A DIFFICULT BUT HOPEFUL START? 10
11. The Old Republic: continuation and reforms 11
1.2 Social protection schemes in the Old Republic 15
12 1 Private social protection schemes 16
1.2.2. The Eloy Chaves Law: the first move from private social protection to
social security 20
1.3. Consolidation of public health functions 24
1 4 Concluding remarks: an outline for the future9 3 1
2. SOCIAL LEGISLATION AND HEALTH CARE UNDER VARGAS (1930
1945): BRAZILIAN WORKERS THE BEST OFF IN THE WORLD1 33
2.1 The Revolution of 1930: the birth of a new social, economic and political
order 34
2.2. Previdencia Social: social protection based on occupational slatus 42
2.3 The Estado Novo: the heyday of public health 50
2.4 Concluding remarks 56
3. THE POPULIST REPUBLIC: THE STRUGGLE OVER SOCIAL
SECURITY AND HEALTH SYSTEM REFORM 59
3.1. The Populist Republic change and continuity 60
3.2. The Previdencia Social: the struggle over unification 65
3.2.1. The struggle over the unification of the IAPs 65
3.2.2. The LOPS: political engineering 70
3 2 3. The ongoing change of the Previdencia Social 72
vi CONTENTS
3 3. The stmggle over unification of health services 75
3.3.1. The rise of medico hospital care 75
3.3.2. The struggle over a national health policy 81
3.3. Concluding remarks 88
4. THE MILITARY REGIME: GROWTH AND CONSOLIDATION OF
BRAZIL S WELFARE STATE EDIFICE 89
4.1. The old is dying but the new cannot be born : Brazil 1964 1979 91
4.2. Previdencia Social and health care: stratification and dualism 94
4.2.1. Administrative reform 95
4.2.2. Consolidation of the social health insurance model 97
4.2.3. The implementation of national insurance fails 102
4.2.4. Modernizing the public sector 103
4.2.5. Expansion of social security coverage 106
Social security for the rural population 106
Expansion of the urban social security system 108
4.2.6. Structuring of national social protection schemes 111
Consolidation of the Social Security System 111
The National Health System 113
4.2.7. The National Health System: consolidation of the status quo or instrument
for change? 115
4 2.8. Social Security takes the lead in health care restructuring 117
4.2.9. PPA paves the way for the Reforma Sanitaria 119
4 2.10 Stratification of health care 121
4 3 Towards universalization or americanization ? 126
4.4. Evolving scenarios 129
5. POLITICAL TRANSITION AND HEALTH CARE REFORM 131
5.1. The vicissitudes of political transition 133
5.2. The Emergence of the Movimento Sanitario 135
5.2.1. The institutional embryo of the discourse of health care reform 135
5.2.2. Acces to the center of power 13 8
5 2 3. The diffusion of ideas 142
5 2.4. Ideology and political leadership 146
5.2.5. The basis of the movement 150
5.3. Struggle for Health Care Reform 153
5.3.1. From programmes of health care extension towards a single public health
system 153
5.3.2. PREV SAUDE: a vain attempt to create a single public health system 154
5.3.3. Social security s fiscal crisis: the kickoff for health care reform 157
Health care as scapegoat 158
The debate on social security health care 160
CONASP: an unexpected move towards health care restructuring 162
Putting the CONASP plan into action 165
The impact of CON ASP 166
5.4. (P)AIS in Minas Gerais 169
5.5. Concluding remarks 174
CONTENTS mi
6. THE REFORMA SANITARIA 175
6 1 Social Policies in the New Republic: promises and constraints 176
6.2. A health platform for the New Republic 182
6 3. The Political Discourse ofReforma Sanitaria 185
64 Executive policy making: the implementation of critical reform
programmes 191
6.4.1. AIS: a strategy for comprehensive reform 192
6.4.2. SUDS: the Cruzado Plan of the health sector9 193
6.4.3. The critical influence of political relations on the process of
decentralization and unification 196
6 4 4. Haste and unplanned decentralization exacerbate the inefficiency of the
public system 199
6.4.5 Managing the relationship with private providers 200
6.4.6. Expansion of the public sector: better access to health care? 204
6 4 7. Municipalization: the way to better health care? 207
6.5. The reform of health care legislation 212
6.5.1 The New Constitution: victory of the Movimento Sanitario9 212
6.5.2. The Health Code: escalation of conflicts 217
6.6. Concluding remarks ambiguities and unresolved problems 223
7. THE GAP BETWEEN DISCOURSE AND PRACTICE 225
7.1 Healht care reform: what should be changed and how should it be done 226
7.1.1. The contracted private network: main culprit or scapegoat? 228
7.1.2. The dynamics of the private sector 233
7.2. End and means of the Reforma Sanitaria 239
7.2.1. The Reforma Sanitaria: policy reform or political reform9 240
7.2.2. Citizenship: the leading principle of the Reforma Sanitaria 247
7.2.3. The Sistema Unico de Saude: the main purpose of the Reforma Sanitaria 248
7.2.4. The principles of the Sistema Unico de Saiide 253
Universality and equity 253
Comprehensive care 256
Decentralization and social control 257
7.3 Concluding remarks: slow revolution or permanent crisis9 259
CONCLUSION 263
Bibliography 269
Interviews 291
Samenvatting 292
Resumo 297
Curriculum vitae 302
Tables
3.1 Percentage of budget allocation earmarked for social security and assistance which
was actually released, 1946 1964 69
3.2. Contributors to the Previdencia Social, absolute numbers and proportions of total
population and economically active population in 1940, 1950, and 1960 73
3 3 Hospitals according to type of ownership; absolute number and percent
distribution in selected years, 1956 1967. 75
3 4. Public and private hospitals beds; absolute number and percent distribution in
selected years, 1950 1975 76
3.5 Preventive and curative shares of Brazilian health expenditures; percent
distribution in selected years, 1949 1982 76
3.6. Medical schools in Brazil, 1900 1975. 78
3.7. Number of medical doctors in Brazil in selected years, 1958 1975 78
3 8. Ministry of Health budgets and annual expenditures as a percentage of total
national budget and expenditures, 1961 1964 82
3.9. DNERu expenditures in comparison with the expenditures on other public health
programmes, 1956 1964 85
4.1 Hospitals according to type of ownership; absolute number and percent
distribution in selected years, 1967 1985 99
4.2. Public and private hospital beds, absolute number and percent distribution in
selected years, 1965 1985 99
4.3. Health care provisions per 1000 habitants in Brazil by region, 1970 100
4 4. Number of contributors to the urban social security system, urban population and
the proportion of urban population covered, 1971 1981 110
4.5. Hospitalizations and medical consultations for social security, 1971 1980 110
4.6. Ministry of Health s annual expenditures as percentage of total national
expenditures, 1970 1984 116
4.7. Number of agreements between INPS and public or private organizations for
providing health care, 1976 118
x TABLl S
4.8. INPS/INAMPS total health care expenditures as share of SINPAS total
expenditures, 1970 1982 118
4.9. Number of contracts of INPS/INAMPS with companies and population covered,
1973 1979 122
5.1. 1NAMPS expenditures in value and percentage of total SINPAS expenditures,
1980 1988 159
5.2. IN AMPS paid hospitalizations and medical consultations in selected years, 1981
1990 167
5.3. Percent distribution of INAMPS expenditures by category of service provider,
1981 1989 168
6.1. Number and distribution of delegates at Brazil s National Health Conferences by
institution or category, IV Conference up to and including the VIII Conference 187
6.2. State governments expenditures on health, total expenditures and by source, 1980
1990 196
6.3. Public hospitals according to ownership by region in 1987 and 1990 198
6.4. INAMPS payment to different private service providers, 1981 1989 203
6.5 Outpatient health facilities according to ownership by category; absolute numbers
and percent distribution in 1988 and 1990 204
6.6. Hospitals according to ownership by region; absolute numbers and percent
distribution in 1987 and 1990 205
6.7. Medical consultations by category of provider; absolute number and percent
distribution, 1987 and 1990 205
6 8 Hospital admissions by category of provider; absolute numbers and percent
distribution, 1987 and 1990 206
6.9 Health expenditures as a percentage of total expenditures by level of government,
1980 1990 208
6.10 Municipal expenditures on health, total expenditures and by source, 1980 1990 209
7.1. Estimated population covered by private health insurance; absolute numbers and
percent distribution by form of private health insurance, 1987 and 1989 235
7.2. Percentage of population that made out of pocket medical payments by household
income groups, 1986 236
7.3 Health care provisions per 1,000 population in Brazil s five major regions, 1970
and 1990 254
7.4. Medical consultations and hospital admissions per 1,000 population in Brazil s five
major regions, 1990 255
Boxes
2.1 The Previdencia Social, 1934 1966 44
4.1 SINPAS National System of Social Security and Assistance, 1977 1990 112
4 2 SNS National Health System (law 6,299/1975) 114
|
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| spelling | Stralen, Cornelis Johannes van Verfasser aut The struggle over a national health care system the movimento sanitário and health policy-making in Brazil, 1960 - 1990 = De strijd om een nationaal gezondheidszorgsysteem door Cornelis Johannes van Stralen De strijd om een nationaal gezondheidszorgsysteem 1996 XX, 301 S. txt rdacontent n rdamedia nc rdacarrier Utrecht, Univ., Diss., 1996 Gesundheitswesen (DE-588)4020775-4 gnd rswk-swf Gesundheitspolitik (DE-588)4113743-7 gnd rswk-swf Brasilien (DE-588)4008003-1 gnd rswk-swf (DE-588)4113937-9 Hochschulschrift gnd-content Brasilien (DE-588)4008003-1 g Gesundheitswesen (DE-588)4020775-4 s Gesundheitspolitik (DE-588)4113743-7 s DE-604 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=007205440&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Stralen, Cornelis Johannes van The struggle over a national health care system the movimento sanitário and health policy-making in Brazil, 1960 - 1990 = De strijd om een nationaal gezondheidszorgsysteem Gesundheitswesen (DE-588)4020775-4 gnd Gesundheitspolitik (DE-588)4113743-7 gnd |
| subject_GND | (DE-588)4020775-4 (DE-588)4113743-7 (DE-588)4008003-1 (DE-588)4113937-9 |
| title | The struggle over a national health care system the movimento sanitário and health policy-making in Brazil, 1960 - 1990 = De strijd om een nationaal gezondheidszorgsysteem |
| title_alt | De strijd om een nationaal gezondheidszorgsysteem |
| title_auth | The struggle over a national health care system the movimento sanitário and health policy-making in Brazil, 1960 - 1990 = De strijd om een nationaal gezondheidszorgsysteem |
| title_exact_search | The struggle over a national health care system the movimento sanitário and health policy-making in Brazil, 1960 - 1990 = De strijd om een nationaal gezondheidszorgsysteem |
| title_full | The struggle over a national health care system the movimento sanitário and health policy-making in Brazil, 1960 - 1990 = De strijd om een nationaal gezondheidszorgsysteem door Cornelis Johannes van Stralen |
| title_fullStr | The struggle over a national health care system the movimento sanitário and health policy-making in Brazil, 1960 - 1990 = De strijd om een nationaal gezondheidszorgsysteem door Cornelis Johannes van Stralen |
| title_full_unstemmed | The struggle over a national health care system the movimento sanitário and health policy-making in Brazil, 1960 - 1990 = De strijd om een nationaal gezondheidszorgsysteem door Cornelis Johannes van Stralen |
| title_short | The struggle over a national health care system |
| title_sort | the struggle over a national health care system the movimento sanitario and health policy making in brazil 1960 1990 de strijd om een nationaal gezondheidszorgsysteem |
| title_sub | the movimento sanitário and health policy-making in Brazil, 1960 - 1990 = De strijd om een nationaal gezondheidszorgsysteem |
| topic | Gesundheitswesen (DE-588)4020775-4 gnd Gesundheitspolitik (DE-588)4113743-7 gnd |
| topic_facet | Gesundheitswesen Gesundheitspolitik Brasilien Hochschulschrift |
| url | http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=007205440&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA |
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