A critical look at the decentralization of public health services in hospital care

Abstract

This study aims to identify the Brazilian National Health System contracting scenario of the  nonprofit private sector for the accomplishment of medium and high complexity health services in hospital care and its relationship with the system decentralization guideline, which should guarantee care from the large urban centers, to areas where public services are scarcer. It is questioned if the expanded contracting of private hospital services represents a departure from the national and state directorates of the execution of the health services from the generalized municipalization of services. The research methodology is exploratory and descriptive, based on the Health and Administrative Law literature. From the analysis of public expenditure on hospital services, in the last five years, it is identified that nonprofit organizations had more investment in hospital production than the direct and indirect public administration spheres of all public entities. To contribute to the search for solutions to the problem, it is concluded that the process of less participation of the national Brazilian National Health System management in the provision of health services entails the greater purchase of services from the private sector by the entities, disregarding the constitutional determination of complementarity of the private sector’s participation in the Brazilian National Health System. In addition, the provision of hospital services in these ways promotes a lack of balance in the allocation of hospital beds, which compromises equal conditions in access to health services and actions, that is the descentralization objective, and the proper functioning of the Brazilian National Health System