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2017 | OriginalPaper | Buchkapitel

6. Political and Institutional Drivers of Social Security Universalization in Brazil

verfasst von : Marcus André Melo

Erschienen in: Towards Universal Health Care in Emerging Economies

Verlag: Palgrave Macmillan UK

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Abstract

Brazil’s experience in building a relatively successful universal health system was made possible by the combination of political incentives to serve poor constituencies, which made it politically sustainable; fiscal sustainability and the great extractive capacity of the Brazilian state; and the institutional capacity to run a complex decentralized system. This chapter argues that Brazil’s Unified Health System (SUS) has faced two important challenges: finding new financial resources for the sector and promoting efficiency gains. Finding new sources of funding has involved unprecedented political costs despite the increasing saliency of public health in the public agenda. Efficiency gains are also unlikely to occur in the near future due to the recent deterioration of public sector management since 2012 and other specific factors, including the judicialization of health care.

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Vorheriges Kapitel The Impacts of Universalization: A Case Study on Thailand’s Social Protection and Universal Health Coverage

Nächstes Kapitel Universalizing Health Care in Brazil: Opportunities and Challenges

The World Health Report 2010 defines the principle in prima facie similar fashion: universal health coverage as a target in which “all people have access to services and do not suffer financial hardship paying for them” (WHO 2010: 9). But this definition involves a consideration of capacity to pay that is absent from the former definition. As is demonstrated in this chapter, this has produced some perversity in the SUS system.

See Skocpol (1991), Antonnen (2002), Mkandawire (2005) and Antonnen et al. (2012). Social security is also a contested concept with regional variations in the usage of the term. Whereas in the US it refers primarily to old age, survivors and disability insurance, and welfare, in Europe as well as in Brazil, after 1988, it denotes social assistance, pension provisions and health care.

The Partido do Movimento Democrático Brasileiro was the main opposition party under the dictatorship and the Partido da Frente Liberal was founded by a group of defectors from Arena, the party that supported the military regime.

Interestingly, most urban unions—along with senior bureaucrats in the planning and finance ministries—opposed this move, arguing that it might jeopardize the financial basis of the system, but it was strongly supported by the Confederation of Agricultural Workers (Contag) and by reformist legislators and bureaucrats.

Previously, patients had to produce proof of an employment relationship prior to being admitted to the system.

Rudra and Haggard (2005), Segura-Ubiergo (2007), Rudra (2007).

Since the time of writing, another presidential impeachment has taken place—that of Dilma Rousseff—amidst a large corruption scandal, political instability and a severe economic recession.

Latin American Public Opinion Project (LAPOP) 2012 data. Accessed 13 February 2014. www.vanderbilt.edu/lapop.

Saúde + 10 is a proposal for health expenditure to be earmarked at 10 percent of current federal expenditure.

Alston, Lee, Marcus André Melo, B. Mueller, and C. Pereira. 2013. Changing social contracts: Beliefs and dissipative inclusion in Brazil. Journal of Comparative Economics 1: 4–22.

Antonnen, Anneli. 2002. Universalism and social policy: A Nordic feminist reevaluation. Nordic Journal of Gender Research 2(70): 70–84.

Antonnen, Anneli, L. Haikio, and K. Stefansson (eds.). 2012. Welfare state, universalism and diversity. Cheltenham: Edward Elgar.

Barrientos, Armando. 2013. The rise of social assistance in Brazil. Development and Change 44(4): 887–910.CrossRef

Biehl, J., Adriana Petryna, Alex Gertner, Joseph J. Amon, and Paulo D. Picon. 2009. Judicialization and the right to health in Brazil. The Lancet 373(27): 2183.

Carnes, Matthew, and Isabella Mares. 2012. Risk and reversals: Explaining individual-level support for public social insurance expansion in Latin America. Paper prepared for presentation at the annual meeting of the American Political Science Association, New Orleans, 29 August–2 September 2012.

CNI (Confederação Nacional da Indústria). 2012. Retratos da sociedade brasileira: Saúde pública. Pesquisa CNI-IBOPE. Brasilia: CNI. http://ecos-redenutri.bvs.br/tiki-download_file.php?fileId=92. Accessed Mar 2016.

ECLAC (Economic Commission for Latin America and the Carribbean). 2009. CEPALSTAT databases and statistical publications. http://estadisticas.cepal.org/cepalstat/WEB_CEPALSTAT/Portada.asp?idioma=i. Accessed 23 Oct 2012.

Faletti, Tulia. 2010. Infiltrating ‘The state’: The evolution of health care reforms in Brazil, 1964–1988. In Explaining institutional change: Ambiguity, agency, and power, ed. James Mahoney and Kathleen Thelen, 38–62. New York: Cambridge University Press.

Gragnolati, Michele, Magnus Lindelow, and Bernard Couttolenc. 2013. Twenty years of health system in Brazil: An assessment of the Sistema Único de Saúde. Washington DC: World Bank.CrossRef

Kuhn, Diane Marie. 2012. Health care reform in Mexico and Brasil: The politics of institutions, spending and performance. PhD Dissertation in Government, Harvard University.

Leite, Adailton Amaral Barbosa. 2010. Descentralização, responsabilização e (des) controle: Determinantes e impactos da corrupção e má gestão dos recursos federais nos municipios brasileiros. PhD Dissertation in Political Science, Universidade Federal de Pernambuco.

Longo, Francisco. 2006. Análisis comparativo por indices. In Informe sobre la situación del servicio civil en América Latina, ed. Koldo Echebarría, 573–592. Washington, DC: Inter-American Development Bank.

Mares, Isabella, and Matthew Carnes. 2009. Social policy in developing countries. Annual Review of Political Science 12: 93–113.CrossRef

Medici, A. 2003. Family spending on health in Brazil: Some indirect evidence of the regressive nature of public spending in health. Technical Paper Series. Inter-American Development Bank, Sustainable Development Department, Washington, DC.

Melo, Marcus André. 1993. Anatomia do fracasso: Intermediação de interesses e a reforma das políticas sociais na Nova República. Dados Revista de Ciências Sociais 36(1): 119–164.

———. 2003. When institutions matter: A comparison of the politics of social security, administrative and tax reforms. In Reinventing leviathan: The politics of administrative reform in developing countries, ed. Ben Ross Schneider, 211–251. Miami: North South Center Press at the University of Miami.

Melo, Marcus André. 2007a. Unexpected successes, unanticipated failures: Social policy from Cardoso to Lula. In Democratizing Brazil revisited, ed. Peter Kingston and Timothy Powers, 161–184. Pittsburgh: University of Pittsburgh Press.

Melo, Marcus André. 2007b. Political competition can be positive: Embedding cash transfer programmes in Brazil. In Development Success: Statecraft in the South, ed. Anthony Bennington and William McCourt 30–51. London: Palgrave Macmillan.

Melo, Marcus André, A. Leite, and E. Rocha. 2012. Competitive corruption: Evidence from randomized municipal audits in Brazil. Paper presented at the annual meeting of the American Political Science Association, New Orleans, 29 August–2 September.

Melo, Marcus André, Armando Barrientos, and André Coelho. 2014. Taxation, redistribution and the social contract in Brazil, IRIBA Working Paper11, University of Manchester, UK.

Menicucci, Telma M.G., and Jose Angelo Machado. 2010. Judicialization of health policy in the definition of access to public goods: Individual rights versus collective rights. Brazilian Political Science Review 4(1): 33–69.

Mkandawire. T. 2005. Targeting and universalism in poverty reduction. Social policy and development programme Paper No. 23. Geneva: UNRISD.

Mobarak, Ahmed, A.A. Rajkumar, and Maureen Cropper. 2011. The political economy of health services provision in Brazil. Economic Development and Cultural Change 59(4): 723–751.CrossRef

Paim, Jairnilson, Claudia Travassos, Celia Almeida, Ligia Bahia, and James Macinko. 2011. The Brazilian health system: History, advances, and challenges. The Lancet 377(9779): 1778–1797. Also published as O sistema de saúde brasileiro: História, avanços e desafios. Série Saúde no Brasil 1. The Lancet 9 May: 11–31.

Piola, Sérgio F., Andrea Barreto de Paiva, Edvaldo Batista de Sá, and Luciana Mendes Santos Servo. 2013. Financiamento público da saúde: Uma história à procura de rumo. Texto para discussão, 1846. Rio de Janeiro: IPEA.

Rodin, J., and David de Ferranti. 2012. Universal health coverage: The third global health transition? The Lancet 380(9845): 861–862.CrossRef

Rudra, Nita. 2007. Welfare states in developing countries: Unique or universal? Journal of Politics 69(2): 378–396.CrossRef

Rudra, Nita, and Stephan Haggard. 2005. Globalization, democracy and ‘Effective’ welfare spending in the developing world. Comparative Political Studies 38(9): 1015–1049.CrossRef

Savedoff, William D., David de Ferranti, Amy L. Smith, and Victoria Fan. 2012. Political and economic aspects of the transition to universal health coverage. The Lancet 380: 924–932.CrossRef

Segura-Ubiergo, Alex. 2007. The political economy of the welfare state in Latin America: Globalization, democracy and development. Cambridge: Cambridge University Press.CrossRef

Skocpol, T. 1991. Targeting within universalism: Politically viable policies to combat poverty in the United States. In The urban underclass, ed. C. Jencks and P.E. Peterson, 411–436. Washington, DC: The Brookings Institution.

Ter-minassian, Tereza. 2013. Improving social spending for a better life for all in Brazil. Vox LACEA. www.vox.lacea.org/?q=brazil_social_spending. Accessed 2 Mar 2016.

WHO (World Health Organization). 2010. World health report 2010: Health systems financing: The path to universal coverage. Geneva: WHO.

Titel: Political and Institutional Drivers of Social Security Universalization in Brazil
verfasst von: Marcus André Melo
Verlag: Palgrave Macmillan UK
Buch: Towards Universal Health Care in Emerging Economies
Print ISBN: 978-1-137-53376-0

Electronic ISBN: 978-1-137-53377-7

Copyright-Jahr: 2017
DOI: https://doi.org/10.1057/978-1-137-53377-7_6