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Plan to increase private involvement in health rebuffed by population

. Oct 31, 2020
health brazil Photo: Tarcisio Schnaider/Shutterstock

One of the recurring criticisms of Brazil’s Economy Ministry, led by the ultraliberal Paulo Guedes, has been its failure to execute a single privatization project in 22 months in office. After struggling to make progress on plans to privatize state-owned electricity firm Eletrobras — the intended first step toward Mr. Guedes’ wild promise to sell off “every single state-owned company” — the Economy Ministry made a curious turn toward the country’s public health system.

Advisors of Mr. Guedes told The Brazilian Report that the cabinet minister deemed privatizing parts of the health system would be “easier” to sell to Congress — and he was dead wrong.

</p> <p>On Tuesday, the government published a degree including <a href="https://brazilian.report/power/2018/07/11/brazil-public-healthcare-system/">primary healthcare facilities</a> in the scope of the federal concession and privatization program. This would open the door for tens of thousands of basic neighborhood health units — which guarantee free healthcare to any Brazilian resident — to be passed on to the private sector.</p> <p>While initially flying under the radar, the decree was picked up by the press and lambasted by specialists, health professionals, economists, political pundits, and members of the public alike.</p> <p>Figures from the Brazilian Institute of Geography and Statistics (IBGE) show that 71.5 percent of the population relies exclusively on the public health service for treatment. And basic health units are the first port of call for these more than 150 million people.</p> <iframe src="https://open.spotify.com/embed-podcast/episode/7DCpGghOuPjJLZWmZPOgnj" width="100%" height="232" frameborder="0" allowtransparency="true" allow="encrypted-media"></iframe> <hr class="wp-block-separator"/> <p>Signed by Mr. Guedes and President Jair Bolsonaro, the decree was treated as the beginning of a process to privatize Brazil&#8217;s entire public health system (SUS). It forecast &#8220;studies for partnerships with the private sector for the construction, modernization, and operation of basic health units.&#8221;</p> <p>Wide-reaching social media campaigns to &#8220;defend SUS&#8221; quickly showed the public&#8217;s staunch opposition to the project, and the government quickly canceled the decree, with Messrs. Bolsonaro and Guedes both declaring they have no intention to privatize the SUS.</p> <p>&#8220;Lamentably people on the left criticized it, the press criticized it, and they were turning me into a monster. So, I revoked the decree, no problem,&#8221; said President Bolsonaro. In turn, Paulo Guedes said that privatizing the SUS &#8220;would be insanity,&#8221; and that the decree intended to find &#8220;how the private sector could help&#8221; the health system.</p> <h2>The private parts of the public health system</h2> <p>Despite the <a href="https://g1.globo.com/ciencia-e-saude/noticia/2020/10/27/decreto-libera-estudos-sobre-a-privatizacao-de-unidades-de-basicas-de-saude.ghtml">immense backlash</a> at the idea of increasing private involvement in Brazil&#8217;s public health system, there are in fact several aspects of the SUS which already have private participation.</p> <p>For instance, several public health services in states and municipalities are managed by the so-called Social Organizations (or OSs), which are private non-profit organizations that receive public funding and equipment and may bypass several rules observed by public health managers, such as auctions for procuring materials and equipment, and public selection processes for hiring personnel.</p> <p>In addition, Public-Private Partnerships (PPPs) have been implanted in the Brazilian health system since 2010, consisting of private sector groups receiving concessions to run hospitals and provide care, with members of the public remaining free from any treatment costs. Indeed, the intention of this week&#8217;s decree was to include basic health units in the PPP program and is part of a slow and gradual process being developed since the 1990s, when OSs were first created

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Renato Alves

Renato Alves is a Brazilian journalist who has worked for Correio Braziliense and Crusoé.

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