Cordeiro H. Descentralização, universalidade e equidade nas reformas da saúde. [Decentralization, universality, and equity in health reforms.] Ciência e Saúde Coletiva [Science and Collective Health] ( Rio de Janeiro , Brazil ) 2001; 6(2):319-328.

Objectives: To contextualize policies applied in the field of health during the 1990s in Brazil , focusing on two contradictory points: 1) the mandate contained in the 1988 Federal Constitution and in the Organic Health Law of 1990; 2) the neo-liberal wave that, under the pressures exerted by the globalization of capital, influenced state reforms throughout Latin America .

Methodology: Analytical and interpretive.

Results: The reform of the health sector, as envisioned in the Constitution and the Organic Law of Brazil, is being carried out, but with oscillations, advances, and setbacks. These conditions create ambiguities, conflicts, and contradictions with respect to changes, beginning in 1990, that affect the role of the Brazilian state.

The author analyzes and puts into context the processes of reform followed in Brazil , demonstrating the difficulties in establishing a unified health system in an environment of multiple healthcare markets regulated by different government agencies. The author also analyzes the impact of reforms on the process and routines of healthcare work and points out the effects exerted by policies of economic adjustment.

Conclusions: The author shows how the Brazilian state lost the ability to formulate and to implement national development policies, as it focused on fiscal adjustment, under the influence of globalized capital.

Copyright 2007 University of New Mexico