Article

Dados vol. 39 n. 3 Rio de Janeiro 1996

A Política Pública como Caixa de Pandora: Organização de Interesses, Processo Decisório e Efeitos Perversos na Reforma Sanitária Brasileira - 1985-1989

Pereira, Carlos

Abstract

The article's main purpose is to study the pattern of interest intermediation in public health policy and, more specifically, to examine the relations forged between interest groups and institutional actors within differing decision-making arenas during the evolution of the so-called Brazilian Sanitation Reform which took place in 1985-89. In empirical terms, the analysis centers on the reform's decisive landmarks, to wit: Brazil's 8th National Health-care Conference, the Unified and Decentralized Health-care System (SUDS), and the Single Health-care System (SUS). In methodological terms, the focus is on the strategic choices made by actors within the decision-making process. Drawing an analogy between the myth of Pandora and the Brazilian Sanitation Reform, the analysis explores the reform's unexpected outcomes and their socially undesirable effects. The profile of public health policy that has emerged from this reform is one that reflects a paradoxical process of universalization and exclusion, in which the principle of social citizenship - grounded on solidarism and universal access to health care - has been steadily undermined, giving way instead to market logic as the prime via of access to health care. Perversely and paradoxically, the state has come to intervene in a selective and merely residual fashion

Keywords: Public policy, interest organization, sanitation reform, decision-making process

DOI: 10.1590/S0011-52581996000300006

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