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2 - Infiltrating the State: The Evolution of Health Care Reforms in Brazil, 1964–1988

Published online by Cambridge University Press:  05 June 2012

By
Tulia G. Falleti
Edited by
James Mahoney  and
Kathleen Thelen
James Mahoney
Affiliation:
Northwestern University, Illinois
Kathleen Thelen
Affiliation:
Massachusetts Institute of Technology
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Summary

Policy in Brazil changes by accretion rather than by substitution.

Schmitter 1971, 256

In the last two decades, Brazil's health care system has undergone two major transformations: universalization and municipalization. Prior to 1988, the administration of the health care system was centralized in the federal government. The member states and the municipalities had a minimal role in the management and delivery of health care. National funding was channeled, via contracts, to the private sector, and inequalities in the provision of services were pervasive. A large portion of the population did not have access to health care, either because they were uninsured or because there were no health facilities in the areas where they lived.

Two decades later the system has been radically reconfigured. In the new health care system, coverage is universal, access is free, public services are integrated, and the delivery of health care is decentralized. The private sector continues to exist alongside the public sector, but its importance as a contractor for the public system has diminished significantly. The Brazilian states and some of the large municipalities are responsible for high-complexity health services, and all of the municipalities – more than fifty-five hundred in total – deliver basic health care services.

This development is puzzling in light of existing theories that all point to insurmountable political barriers to universalization in a context such as Brazil. Several features of the previous system should have dampened efforts in this direction.

Type
Chapter
Information
Explaining Institutional Change
Ambiguity, Agency, and Power
 , pp. 38 - 62
Publisher: Cambridge University Press
Print publication year: 2009

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References

Adler, Emanuel. 1986. “Ideological ‘Guerrillas’ and the Quest for Technological Autonomy: Brazil's Domestic Computer Industry.” International Organization 40 (3): 673–705.CrossRefGoogle Scholar
Arretche, Marta. 2004. “Toward a Unified and More Equitable System: Health Reform in Brazil.” In Crucial Needs, Weak Incentives. Social Sector Reform, Democratization, and Globalization in Latin America, ed. Kaufman, R. R. and Nelson, J. M., 155–188, Washington, DC, Baltimore, and London: Woodrow Wilson Center Press and Johns Hopkins University Press.Google Scholar
Capoccia, Giovanni, and Keleman, Daniel. 2007. “The Study of Critical Junctures: Theory, Narrative and Counterfactuals in Historical Institutionalism.” World Politics 59 (3): 341–369.CrossRefGoogle Scholar
,CEBES. 1980. “A Questão Democrática na Área da Saúde.” Saúde em debate 9:11–13.Google Scholar
,CONASS. 2007. CONASS 25 anos. Brasília: Conselho Nacional de Secretários de Saúde.Google Scholar
Cordeiro, Hésio. 2001. “Descentralização, Universal Access, and Equity in Health Reforms.” Ciência & Saúde Coletiva 6 (2): 319–328.CrossRefGoogle Scholar
Draibe, Sônia M. 1994. “As políticas sociais do regime militar brasileiro: 1964–84.” In 21 anos de regime militar: Balanços e perspectivas, ed. Soares, G. A. D. and d'Araujo, M. C., 271–309. Rio de Janeiro, RJ: Editora da Fundação Getúlio Vargas.Google Scholar
Erickson, Kenneth Paul. 1977. The Brazilian Corporative State and Working-Class Politics. Berkeley: University of California Press.Google Scholar
Escorel, Sarah. 1999. Reviravolta na Saúde: Origem e articulação do movimento sanitário. Rio de Janeiro: Editoria FIOCRUZ.CrossRefGoogle Scholar
Escorel, Sarah, and Bloch, Renata Arruda. 2005. “As Conferências Nacionais de Saúde na Construção do SUS.” In Saúde e democracia. História e perspectivas do SUS, ed. Lima, N. T., Gerschman, S., Edler, F. C., and Suárez, J. M., 83–119, Rio de Janeiro: Editora FIOCRUZ and OPS/OMS.Google Scholar
Escorel, Sarah, Nascimento, Dilene Raimundo, and Edler, Flavio Coelho. 2005. “As Origens da Refomra Sanitária e do SUS.” In Saúde e democracia: História e perspectivas do SUS, ed. Lima, N. T., Gerschman, S., Edler, F. C., and Suárez, J. M., 59–81, Rio de Janeiro: Editora FIOCRUZ and OPS/OMS.Google Scholar
Falleti, Tulia G. 2007. “S'emparer du pouvoir ou créer du pouvoir? Les héritages des régimes militaires dans la décentralisation en Argentine et au Brésil” [To Seize or to Create? The Legacies of Militarism on Decentralization in Argentina and Brazil], Critique internationale (Presses de Sciences Po, Paris, France), No. 35, April-June: 101–117.Google Scholar
Falleti, Tulia G., and Lynch, Julia. 2009. “Context and Causal Mechanisms in Political Analysis,” Comparative Political Studies, 42 (9), prepublished April 21, 2009 as doi:10.1177/0010414009331724.CrossRefGoogle Scholar
Figueiredo, Argelina Maria Cheibub, Torres, Haroldo da Gama, deSouza Motta, Celina Maria, Bichir, Renata Mirandola, Fusaro, Edgard, and Ferreira, Maria Paula. 2007. “Projeto Radar das Condições de Vida e das Políticas Sociais. Fase II.” São Paulo: Centro Brasileiro de Análise e Planejamento-CEBRAP.
Figueiredo, Argelina Maria Cheibub, Torres, Haroldo da Gama, Limongi, Fernando, Arretche, Marta, Ferreira, Renata Bichir, Maria Paula, and Fusaro, Edgard Rodrigues. 2005. Projeto BRA/04?052. Rede de Pesquisa e Desenvolvimento de Políticas Públicas REDE-IPEA II. São Paulo: Centro Brasileiro de Análise e Planejamento-CEBRAP.Google Scholar
Flynn, Peter. 1978. Brazil: A Political Analysis. London and Boulder, CO: Ernest Benn and Westview Press.Google Scholar
Hacker, Jacob. 1998. “The Historical Logic of National Health Insurance: Structure and Sequence in the Development of British, Canadian, and U.S. Medical Policy.” Studies in American Political Development 12 (Spring): 57–130.CrossRefGoogle Scholar
Souza, Hermógenes, Alberto, José. 1980. O Modelo PIASS, Sua Programação e Sua Evolução para o Programa Nacional de Sérvicios Básicos de Saúde. Paper read at 7 Conferência Nacional de Saúde. Anais, at Brasília, DF.
Houtzager, Peter P., and Kurtz, Marcus J.. 2000. “The Institutional Roots of Popular Mobilization: State Transformation and Rural Politics in Brazil and Chile, 1960–1995.” Comparative Studies in Society and History 42 (2): 394–424.CrossRefGoogle Scholar
Kaufman, Robert R., and Nelson, Joan M., eds. 2004. Crucial Needs, Weak Incentives: Social Sector Reform, Democratization, and Globalization in Latin America. Washington, DC, Baltimore, and London: Woodrow Wilson Center Press and Johns Hopkins University Press.
Lewis, Maureen, and Medici, André. 1998. “Health Care Reform in Brazil: Phasing Change.” In Do Options Exist? The Reform of Pension and Health Care Systems in Latin America, ed. Cruz-Saco, M. A. and Mesa-Lago, C., 267–289. Pittsburgh: University of Pittsburgh Press.Google Scholar
Lobato, Lenaura, and Burlandy, Luciene. 2000. “Chapter 4. The Context and Process of Health Care Reform in Brazil.” In Reshaping Health Care in Latin America. A Comparative Analysis of Health Care Reform in Argentina, Brazil, and Mexico, ed. Fleury, S., Belmartino, S., and Baris, E., 79–102. Ottawa, Ontario: International Development Research Center.Google Scholar
Luna, Francisco Vidal, and Klein, Herbert S.. 2006. Brazil since 1980. New York: Cambridge University Press.CrossRefGoogle Scholar
Malloy, James M. 1977. “Authoritarianism and the Extension of Social Security Protection to the Rural Sector in Brazil.” Luso-Brazilian Review 14 (2): 195–210.Google Scholar
Malloy, James M. 1979. The Politics of Social Security in Brazil. Pittsburgh: University of Pittsburgh Press.Google Scholar
McGuire, James W. Forthcoming. Wealth, Health, and Democracy in East Asia and Latin America. New York: Cambridge University Press.CrossRef
,Ministério da Saúde. 1975. V Conferência nacional de Saúde, 5 to 8 of August, at Brasília.
,Ministério da Saúde. 1986a. “8a Conferencia Nacinal de Saúde. Anais.” Brasília.
,Ministério da Saúde. 1986b. “8a Conferencia Nacional de Saúde. 17 a 21 de março de 1986. Relatório final.” Brasília.
,Ministério da Saúde. 1992 [1963]. Anais. 3a. Conferência Nacional de Saúde, Fundação Municipal de Saúde, Niteroi.
,Ministério da Saúde. 2006. “IDB 2006 Brasil – Indicadores e Dados Básicos para a Saúde.” In anual: MS, RIPSA.
Moraes, Clodomir. 1970. “Peasant Leagues in Brazil.” In Agrarian Problems and Peasant Movements in Latin America, ed. Stavenhagen, R.., 453–501. Garden City, NY: Anchor Books.Google Scholar
Neto, Eleutério Rodrigues. 1997. “A Vio do Parlamento.” In Saúde e democracia: A luta do CEBES, ed. Fleury, S.. São Paulo, S. P: Lemos Editorial & Gráficos Ltda.Google Scholar
Nunes Leal, Victor. 1997. Coronelismo, enxada e voto: O município e o regime representativo no Brasil. 3rd ed. Rio de Janeiro: Editora Nova Fronteira.Google Scholar
Oliveira, Jaime A. de Araújo, and Teixeira, Sonia M. Fleury. 1986. (Im)previdência social. 60 anos de história da Previdência no Brasil. Petrópolis (Rio de Janeiro): Vozes and ABRASCO.Google Scholar
Paiva, Carlos Henrique Assunção. 2006. “Samuel Pessoa: Uma trajetória científica no contexto do sanitarismo campanhista e desenvolvimentista no Brasil.” História, Ciência, Saúde – Manguinhos 13 (4): 795–831.CrossRefGoogle Scholar
Rodriguez Neto, Eleutério, Temporão, José Gomes, and Escorel, Sarah. 2003. Saúde: Promessa e limites da constituição. Rio de Janeiro, RJ: Editora Fiocruz.Google Scholar
Samuels, David, and Abrucio, Fernando Luiz. 2000. “Federalism and Democratic Transitions: The ‘New’ Politics of the Governors in Brazil.” Publius: The Journal of Federalism 30 (2): 43–61.CrossRefGoogle Scholar
Schmitter, Philippe C. 1971. Interest Conflict and Political Change in Brazil. Stanford, CA: Stanford University Press.Google Scholar
Stepan, Alfred. 1971. The Military in Politics: Changing Patterns in Brazil. Princeton: Princeton University Press.Google Scholar
Streeck, Wolfgang, and Thelen, Kathleen, eds. 2005. Beyond Continuity: Institutional Change in Advanced Political Economies. Oxford: Oxford University Press.
Sugiyama, Natasha Borges. 2008. “Theories of Policy Diffusion: Social Sector Reform in Brazil.” Comparative Political Studies 41 (2): 193–216.CrossRefGoogle Scholar
Tanaka, Oswaldo Yoshimi, Escobar, Eulália Maria A., Gimenez, Aparecida Silvia M., Camargo, Katia G., Lelli, Carmen L. S., and Yoshida, Tania M.. 1992. “Gerenciamento do setor saúde na década de 80, no Estado de São Paulo, Brasil.” Revista Saúde Pública 26 (3): 185–194.CrossRefGoogle Scholar
Tendler, Judith. 1997. Good Government in the Tropics. Baltimore: Johns Hopkins University Press.Google Scholar
Thelen, Kathleen. 2003. “How Institutions Evolve: Insights from Comparative Historical Analysis.” In Comparative Historical Analysis in the Social Sciences, ed. Mahoney, James and Rueschemeyer, Dietrich, 305–336. Cambridge: Cambridge University Press.Google Scholar
Weyland, Kurt. 1995. “Social Movements and the State: The Politics of Health Reform in Brazil.” World Development 23 (10): 1699–1712.CrossRefGoogle Scholar
Weyland, Kurt. 1996. Democracy Without Equity: Failures of Reform in Brazil. Pittsburgh: University of Pittsburgh Press.Google Scholar
Weyland, Kurt. 2007. Bounded Rationality and Policy Diffusion: Social Sector Reform in Latin America. Princeton: Princeton University Press.Google Scholar

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