The article highlights the importance of institutional factors for the process of formulation and outcomes in health policy. It deals with the Brazilian system for the treatment of terminal chronic kidney failure, because there is a consensus among physicians, patients and analysts about the ideal distribution of resources between transplants and dialysis, which is difficult to be achieved in other public policies. The article discusses the importance of institutional organization, previous policies and rules of financing public health care for the development of the inefficiencies and inequalities of this system. It underscores the need to review the funding rules in this sector and to strengthen the technical and administrative instances responsible for the decentralised management of the Unified Health System (SUS).
Publical policies; Health policy; Institutions; Kidney transplantation; Dialysis
