Privatization of health care management through Social Organizations in the city of São Paulo, Brazil: description and analysis of regulation

The article describes and discusses privatization of the municipal health system in São Paulo, Brazil, from an administrative and political perspective. The methodology consisted of a literature review and analysis of legislation and public documents. The study showed that although legislation governing the so-called "Social Organizations" (OS) in Brazil dates to the year 2006, half of the administrative privatization is still regulated by a previous provisional instrument in the form of an "agreement" ("convênio" in Portuguese). In 2011, 61% of services were administered by private organizations, which received 44% of the health budget in 2012. The twenty participating organizations include five of the ten largest health care companies in Brazil. Inspection agencies have detected flaws in the management contracts, but the "agreements" (convênios) are subject to less rigorous control and have proven invisible to inspection. Finally, the legal framework is unstable. The study uses the experience in São Paulo as the basis for discussing the political versus technical nature of private management in the Brazilian Unified National Health System (SUS).

Health Management; Health Care Reform; Privatization