Fleury S. Mandelli MJ. Equidad y reforma sanitaria: Brasil. [Equity and public health reform: Brazil.] Cuadernos Médicos Sociales [Medico Social Notebooks] (Rosario, Argentina) 1994 November; 69: 21-31.
Objectives: To analyze the process of reform in the Brazilian health system that was established in the Constitution of 1988.
Methodology: Analytic and interpretive.
Results: The authors analyze the Brazilian reform considering it as a point of departure for the analysis the planned system and a strategy for change.
The principal characteristics of the point of departure were: extension of coverage; predominance of curative medical practice; creation, through state intervention, of a medical-industrial complex; predominance of the private sector in the delivery of services; centralization; concentration in large, urban centers; decrease in responsibility of public power; and, the non-existence of health as a right.
The Unified System of Health was projected with the following basic guidelines: a widened conception of health that incorporates the social determinants of the health-illness process; health as a right; equity; holism; health as a public function; health policy as a form of democratic participation; and health as a component of social security.
The strategy of change analyzed in the article includes: construction of the political actor; participation and social control; and decentralization. As problematic areas to advance in the operationalization of reform, the article emphasizes: the public health model, the role of the state, the institutional and financial bases, and social segmentation.
Conclusions: The Brazilian reform confronts its own obstacles in a highly inequitable and fragmented society, with a predominance of sectors that profit from health care and that impose a high-cost, curative model.
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