Comunidade epistêmica e a formação da reforma sanitária no Brasil

Abstract

This paper addresses the policy analysis that underpinned the Brazilian Sanitary Reform (SR), responsible for the defining the Unified Health System and for the proposal to make universal health care a right under the Federal Constitution of 1988 (FC1988). The paper highlights the role of political argumentation by the epistemic community of experts in the health field as central to the redistributive health sector reform. Although Brazil’s health system is defined by the FC1988 as comprising universal access, hegemonic public funding and direct provision of care by the government, today it is fragmented and under huge influence of the private sector. In a comparative perspective, participation by private health insurance is much higher than in other emerging countries. This paper argues that, as FC1988 proposed no veto against the market’s operating in the health sector, private health care and health insurance companies with greater voice have succeeded in imposing preferences in decision-making arenas. The paper concludes that the analysis of the institutional limits of redistributive public policies in Brazil presents a challenge to the SR’s epistemic community today.