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O mixed bang das reformas do sector da saúde pós-2002
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RESUMO - Durante a última década, as experiências de transformação
no sector da saúde, em particular no subsector hospitalar,
seguiram um padrão quase minimalista, sobretudo na
dimensão: uma experiência de gestão privada em hospital
público, uma experiência de unidade local de saúde, uma
experiência, depois outra, de diferentes estatutos para o
hospital público. Em meados de 2002 lança-se uma nova
forma de encarar estas experiências que levou, no início de
2003, a que metade (sensivelmente) dos hospitais do sector
público tivesse sido alvo de uma experiência (a transformação
em sociedades anónimas de capitais exclusivamente
públicos). Discutem-se no presente texto as vantagens e
desvantagens de reformas gradualistas versus big bang.
A empresarialização dos hospitais portugueses constitui
um caminho intermédio, que foi denominado mixed bang.
No contexto nacional, face à incapacidade histórica de
expandir experiências gradualistas, ainda que bem sucedidas,
e às resistências que reformas big bang originam em
áreas onde os actores principais se encontram bem organizados,
o mixed bang surge como uma solução de transformação
que, aparentemente, está a gerar mudanças na
organização hospitalar nacional.
ABSTRACT - Over the last decade, the Portuguese hospital sector has seen several policy experiments, which followed essentially a gradual approach: one experience of private management in public hospital, one experience of integration of primary care and hospital care within the same decision unit, one experience, followed by another one, of statutes approaching «private sector rules» in Government-managed hospital. In mid-2002, a new approach emerged, taking effect from 2003 onwards: essentially half of the hospitals were transformed into privatelike institutions, though within the public realm. We discuss here the merits and disadvantages of gradual vs. big bang type of reforms. The path taken with respect to hospital changes is termed mixed bang. The author argues that based on the historical record of incapacity to expand successful experience episodes (gradual approach) and on the resistance that full blown, big bang, reforms would bring from organized groups, the mixed bang acted as a compromise, and may actually be delivering some changes.
ABSTRACT - Over the last decade, the Portuguese hospital sector has seen several policy experiments, which followed essentially a gradual approach: one experience of private management in public hospital, one experience of integration of primary care and hospital care within the same decision unit, one experience, followed by another one, of statutes approaching «private sector rules» in Government-managed hospital. In mid-2002, a new approach emerged, taking effect from 2003 onwards: essentially half of the hospitals were transformed into privatelike institutions, though within the public realm. We discuss here the merits and disadvantages of gradual vs. big bang type of reforms. The path taken with respect to hospital changes is termed mixed bang. The author argues that based on the historical record of incapacity to expand successful experience episodes (gradual approach) and on the resistance that full blown, big bang, reforms would bring from organized groups, the mixed bang acted as a compromise, and may actually be delivering some changes.
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Citação
Barros, Pedro Pita - O mixed bang das reformas do sector da saúde pós-2002 = The mixed bang of the post-2002 health care reforms. Revista Portuguesa de Saúde Pública. ISSN 0870-9025. Volume temático, Nº 4 (2004), p. 51-56
Editora
Universidade Nova de Lisboa, Escola Nacional de Saúde Pública