The institutional and operational context of the health sector and its significance for the Suds

Abstract

This document is aimed at describing and explaining the main variables limiting the Health sector, giving character to its dynamics and regulating its performance, either isolated or inserted in the framework of Brazilian public administration.

The sector, as a whole, is seen as being composed of public institutions pertaining to the three governmental levels, as well as of private organizations. However, it can not be mingled with other formal arrangements adopted by governments to perform, under a specific pattern, functions concerned with health care, because it takes into account the, boundary, intrusive functional area in which it operates together with other sectors. The same thought, may be valid as to the private sector, here considered in an institutional gradient delimited at its inception by institutions dedicated to medical care and, at its other extremity, by economic organizations instituted for production of goods and services needed by the sector.

The analysis performed tries to define the position of the Suds - Sistema

Unificado e Descentralizado de Saúde (Unified and Decentralized Health System) - in the current political and organizational set of structures composing the sector, to identify trends which may influence its institutionalization, and also to suggest an agenda of directives capable of helping in the adoption of a long-lived process of descentralization, as intends the Sanitary Reform.

The set of identified and analysed variables comprises a large thematic range, varying from institutional arrangements to prosaic problems of administrative and managerial nature, associated with the programming structure of public budgets.