| dc.description.abstract | Whether in its normative aspect, when it envisioned health as a social right, or an institutional one, when considering new functions for the state, changes in Brazilian health policy were stipulated by the Federal Constitution of 1988. The sectors reformulation was institutionally affirmed in the creation of the Unified Health System SUS. Nonetheless, on the eve of three decades of establishing a new legal landmark, it is a fact that healthcare policy presents a dual trajectory, with strong traces of commodification of the right, with its main expression in the consolidation of a system composed by private plans and insurances the Supplementary Healthcare, simultaneous with SUS. The goal of this thesis was to explain the duality of the healthcare policy, despite legal-institutional innovations and variations in the political context specific to the FHC era and the Lula era, respectively, the Brazilian Social Democracy Party and the Workers Party. The theoretical basis for the study was neoinstitutionalism, in particular its historical approach, and how it currently understands the analysis of changes in public policy. Methodologically, a case study was presented using process-tracing as an investigative procedure. The dual aspect of the healthcare policy was analyzed with a sequential description of evidence, uncovered from primary and secondary data. This allowed the retrievement of the history prior to the legal inscription of SUS and, systematically, the tracing of governmental decisions regarding the SUSs financing and the regulation of Supplementary Healthcare, in the 16 years that comprise the governments of FHC and Lula. Considering the combined influence of three factors (the legacy, the rules, and the actors) a causal force of mechanisms was identified: the effect of increasing returns and institutional dissonance. It was concluded that healthcare policy results from a permanent tension between the interpretation and execution of rules, as well as the intentional action of actors that seek to direct healthcare policy according to their visions and interests. An agenda of incremental change in the SUS is made permeated with disagreements on the proposals of universalization of healthcare, regardless of the party in charge of the government and its support coalition which, for several reasons, sometimes different ones, act in order to strengthen the market in this sector | |
