Characteristics and trends in management and provision of contracted services in the SUS

Abstract

The multiplicity of management modalities and provision of public health services and their different forms of contracting is one of the central challenges for the management of the Brazilian Unified Health System, known as SUS. Based on a matrix of analysis of the contracting of health services, the article analyzes, in a macro-region, characteristics and trends of the following modalities: public administration, private non-profit (philanthropic and social organization) and for-profit, state foundation of private law and public health consortium. This is qualitative research, of the multiple case study type, using secondary data and interviews, supported by the historical institutionalist framework. The results are presented from three dimensions (historical-structural, political-institutional and conjunctural) and variables, characteristics and trends of the researched modalities. Among them, the following stand out: the tendency towards commodification and outsourcing of services and workforce in the SUS, an aspect reinforced by modalities and actors linked to the public sphere, in addition to the disarticulation of modalities with the care network. The modality matters and to provide effective care to users it must be guaranteed through effective regulation, governance by public managers and social participation.