Global technological transformations and asymmetries: development strategy and structural challenges for the Unified Health System

Gadelha, Carlos Augusto Grabois; Nascimento, Marco Aurelio de Carvalho; Braga, Patrícia Seixas da Costa; Cesário, Bernardo Bahia

doi:10.1590/1413-81232018237.09452018

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ARTICLE • Ciênc. saúde colet. 23 (7) • July 2018 • https://doi.org/10.1590/1413-81232018237.09452018 copy

Global technological transformations and asymmetries: development strategy and structural challenges for the Unified Health System

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This paper articulates contemporary themes of the development agenda as global phenomena that affect the dissemination and direction of health technical progress, subjecting the sustainability of the Unified Health System (SUS). The evaluation of the external dependence of the Brazilian Health Economic Industrial Complex, the bibliographical review of the literature on economic complexity and its data on Latin America and Brazil and the collection and evaluation of statistical data from the World Intellectual Property Organization and the National Institute of Industrial Property enable us to build an overview of increasing economic and power asymmetries that reiteratesthis centre-periphery pattern in multiple themes and geographical scales. This perspective consolidates the endogenous link between national development patterns and structural possibilities and boundaries for the setting of a Brazilian universal health system. Confronting global technological asymmetries is part of a strategic agenda that conditionsthe advancingof the Unified Health Systemtowards its founding principles of universality, comprehensiveness and equity.

Global health; Health and development; Health economic-industrial complex; Health innovation; Health political economy

Countries by income category	Patents filed
	World total (%)			Residents in relation to filings in the income category (%)			Residents in relation to world filings (%)
	1997	2004	2016	1997	2004	2016	1997	2004	2016
High Income	87.9%	82.8%	49.6%	67.7%	65.3%	59.1%	59.4%	54.1%	29.4%
Upper middle-income (with China)	9.4%	14.4%	47.6%	36.5%	46.0%	85.3%	3.3%	6.6%	40.6%
Upper middle-income (without China)	7.3%	6.2%	4.8%	29.6%	40.0%	42.9%	2.2%	2.5%	2.1%
China	2.1%	8.3%	42.8%	51.2%	50.5%	90.0%	1.1%	4.2%	38.5%
Lower middle-income	2.6%	2.4%	2.4%	29.1%	29.1%	26.7%	0.8%	0.7%	0.6%
Low Income	0.1%	0.4%	0.3%	12.5%	89.6%	86.0%	0.0%	0.4%	0.3%

Technology categories	All categories				Medical technology				Pharmaceuticals
Year	1994	2004	2014	2016	1994	2004	2014	2016	1994	2004	2014	2016
Total grants	398,462	567,986	1,120,351	1,272,616	14,825	23,902	51,848	59,538	10,594	18,172	37,209	35,950
(%) in relation to total grants	100%	100%	100%	100%	3.7%	4.2%	4.6%	4.7%	2.7%	3.2%	3.3%	2.8%
(%) residents	60.5%	61.5%	63.3%	63.6%	63.6%	62.8%	55.6%	53.6%	33.8%	43.0%	50.3%	46.3%
(%) non-residents	39.5%	38.5%	36.7%	36.4%	36.4%	37.2%	44.4%	46.4%	66.2%	57.0%	49.7%	53.7%
High income	358,636	473,498	840,560	811,201	13,020	18,827	42,478	44,952	9,100	11,026	22,781	22,755
(%) in relation to total grants	90.01%	83.36%	75.03%	63.74%	3.3%	3.3%	3.8%	3.5%	2.3%	1.9%	2.0%	1.8%
(%) in the category of technology	90.01%	83.36%	75.03%	63.74%	87.8%	78.8%	81.9%	75.5%	85.9%	60.7%	61.2%	63.3%
Residents - total grants	216,516	303,178	528,167	493,935	8,218	11,449	24,160	25,155	3,138	4,458	9,284	9,003
(%) in the category of income	54.34%	53.38%	47.14%	38.81%	63.1%	60.8%	56.9%	56.0%	34.5%	40.4%	40.8%	39.6%
Non-Residents - total grants	142,120	170,320	312,393	317,266	4,802	7,378	18,318	19,797	5,962	6,568	13,497	13,752
(%) in the category of income	35.67%	29.99%	27.88%	24.93%	36.9%	39.2%	43.1%	44.0%	65.5%	59.6%	59.2%	60.4%
Upper middle-income	38,426	84,058	274,090	457,479	1,744	3,809	9,163	14,399	1,349	5,838	13,718	12,678
(%) in relation to total grants	9.64%	14.80%	24.46%	35.95%	0.4%	0.7%	0.8%	1.1%	0.3%	1.0%	1.2%	1.0%
(%) in the category of technology	9.64%	14.80%	24.46%	35.95%	11.8%	15.9%	17.7%	24.2%	12.7%	32.1%	36.9%	35.3%
Residents - total grants	24,516	38,359	178,829	313,401	1,210	2,360	4,525	6,614	438	2,755	9,328	7,532
(%) in the category of income	6.15%	6.75%	15.96%	24.63%	69.4%	62.0%	49.4%	45.9%	32.5%	47.2%	68.0%	59.4%
Non-Residents - total grants	13,910	45,699	95,261	144,078	534	1,449	4,638	7,785	911	3,083	4,390	5,146
(%) in the category of income	3.49%	8.05%	8.50%	11.32%	30.6%	38.0%	50.6%	54.1%	67.5%	52.8%	32.0%	40.6%
Upper middle-income (except China)	34,554	34,791	47,836	51,628	1,598	2,485	2,540	2,921	1,238	2,777	2,827	3,410
(%) in relation to total grants	8.67%	6.13%	4.27%	4.06%	0.4%	0.4%	0.2%	0.2%	0.3%	0.5%	0.3%	0.3%
(%) in the category of technology	8.67%	6.13%	4.27%	4.06%	10.8%	10.4%	4.9%	4.9%	11.7%	15.3%	7.6%	9.5%
Residents - total grants	22,891	20,857	25,134	22,211	1,125	1,921	1,395	1,231	419	915	918	795
(%) in the category of income	5.74%	3.67%	2.24%	1.75%	70.4%	77.3%	54.9%	42.1%	33.8%	32.9%	32.5%	23.3%
Non-Residents - total grants	11,663	13,934	22,702	29,417	473	564	1,145	1,690	819	1,862	1,909	2,615
(%) in the category of income	2.93%	2.45%	2.03%	2.31%	29.6%	22.7%	45.1%	57.9%	66.2%	67.1%	67.5%	76.7%
CHINA	3,872	49,267	226,254	405,851	146	1,324	6,623	11,478	111	3,061	10,891	9,268
(%) in relation to total grants	0.97%	8.67%	20.19%	31.89%	0.0%	0.2%	0.6%	0.9%	0.0%	0.5%	1.0%	0.7%
(%) in the category of technology	0.97%	8.67%	20.19%	31.89%	1.0%	5.5%	12.8%	19.3%	1.0%	16.8%	29.3%	25.8%
Residents - total grants	1,625	17,502	153,695	291,190	85	439	3,130	5,383	19	1,840	8,410	6,737
(%) in the category of income	0.41%	3.08%	13.72%	22.88%	58.2%	33.2%	47.3%	46.9%	17.1%	60.1%	77.2%	72.7%
Non-Residents - total grants	2,247	31,765	72,559	114,661	61	885	3,493	6,095	92	1,221	2,481	2,531
(%) in the category of income	0.56%	5.59%	6.48%	9.01%	41.8%	66.8%	52.7%	53.1%	82.9%	39.9%	22.8%	27.3%
Lower middle-income	973	9,953	5,422	3,441	47	1,256	202	178	70	1,179	660	443
(%) in relation to total grants	0.24%	1.75%	0.48%	0.27%	0.0%	0.2%	0.0%	0.0%	0.0%	0.2%	0.1%	0.0%
(%) in the category of technology	0.24%	1.75%	0.48%	0.27%	0.3%	5.3%	0.4%	0.3%	0.7%	6.5%	1.8%	1.2%
Residents - total grants	151	7,769	2,148	1,539	6	1,206	137	127	4	590	120	121
(%) in the category of income	0.04%	1.37%	0.19%	0.12%	12.8%	96.0%	67.8%	71.3%	5.7%	50.0%	18.2%	27.3%
Non-Residents - total grants	822	2,184	3,274	1,902	41	50	65	51	66	589	540	322
(%) in the category of income	0.21%	0.38%	0.29%	0.15%	87.2%	4.0%	32.2%	28.7%	94.3%	50.0%	81.8%	72.7%
Low income	427	477	279	495	14	10	5	9	75	129	50	74
(%) in relation to total grants	0.11%	0.08%	0.02%	0.04%	0.1%	0.0%	0.0%	0.0%	0.0%	0.0%	0.0%	0.0%
(%) in the category of technology	0.11%	0.08%	0.02%	0.04%	0.1%	0.0%	0.0%	0.0%	0.7%	0.7%	0.1%	0.2%
Residents - total grants	23	12	0	6	2	1	0	0	3	4	0	1
(%) in the category of income	0.01%	0.00%	0.00%	0.00%	14.3%	10.0%	0.0%	0.0%	4.0%	3.1%	0.0%	1.4%
Non-Residents - total grants	404	465	279	489	12	9	5	9	72	125	50	73
(%) in the category of income	0.10%	0.08%	0.02%	0.04%	85.7%	90.0%	100.0%	100.0%	96.0%	96.9%	100.0%	98.6%

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[1] Collaborations

CAG Gadelha participated in coordination of design, outline and analysis; MAC Nascimento participated in support for design, research and methodology with emphasis on economic complexity; PSC Braga participated in research and methodology with emphasis on intellectual property; and BB Cesário participated in research and methodology with emphasis on foreign trade.