The public-private conflict in SUS: specialized outpatient care in Paraná

ABSTRACT

The fundamental conflict of health in capitalist societies – social right versus commodity – is also expressed within the Unified Health System (SUS). This research analyzed the public-private relationship in the provision of specialized outpatient services by the SUS in the state of Paraná, from 1995 to 2015, in comparison with the national reality. A descriptive study was carried out, with selected procedures, with data collected in the Outpatient Information System (SIA) through the Datasus Tabnet On-line platform in the years 1995, 1999, 2003, 2007, 2011 and 2015. The results demonstrate that specialized outpatient care, secondary and tertiary, has expanded over the past two decades, following the expansion of SUS. The percentage of private participation is, in general, minority in the medium complexity services and majority in the high complexity services, and in Paraná the degree of privatization is considerably higher than at the national scope. Thus, differently from what is constitutionally recommended, in various services and areas of the SUS, it is the public that assumes the role of complementing the private. The possible impacts of the internal privatization of SUS on its limits on constituting itself as a universal, comprehensive and equal system are discussed.

KEYWORDS
Unified Health System; Privatization; Health facilities; proprietary; Secondary care; Tertiary healthcare