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Social Health Organizations and the Performance of the SUS: A Study on Basic Healthcare in São Paulo

Vera Schattan P. Coelho Jane Greve About the authors


The article begins with the debate on the advantages of the use of contracts and the involvement of non-governmental organizations in the provision of public services, focusing on the contracting of social health organizations for the provision of public services in this area. We discuss what leads politicians and public administrators to contract such organizations and how the signed contracts are managed, also assessing the impact on the healthcare offered by the Unified Health System (SUS). The article therefore begins with two approaches – one qualitative and the other quantitative – analyzing the involvement of the organizations in the provision of basic healthcare services in the state of São Paulo. The qualitative study encompassed 4 medium-sized municipalities, while the quantitative study assessed the use of contracts across the state’s 645 municipalities. The results demonstrate that: 1) the municipalities have increasingly come to rely on contracts with social health organizations; 2) Politicians and administrators affiliated to parties with different ideological nuances have adhered to this type of contracts; 3) there are preliminary yet inconclusive indications that the adoption of these contracts has contributed to an increase in the number of medical consultations offered to SUS users, as well as a decrease in the hospitalization of patients that may be treated by basic healthcare.

Unified Health System; social health organizations; agreements; management contracts; political process analysis; impact assessment

Instituto de Estudos Sociais e Políticos (IESP) da Universidade do Estado do Rio de Janeiro (UERJ) R. da Matriz, 82, Botafogo, 22260-100 Rio de Janeiro RJ Brazil, Tel. (55 21) 2266-8300, Fax: (55 21) 2266-8345 - Rio de Janeiro - RJ - Brazil