Financiamento do sus

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Financiamento federal e gestão local de políticas sociais: o difícil equilíbrio entre regulação, responsabilidade e autonomia Federal financing and local management of social policies: the balance among regulation, accountability and autonomy

Marta Arretche 1

Abstract The article argues that local governments had already taken over the management of health care policy in Brazil. Yet, there´s no guarantee that local management will necessarily imply accountability, efficiency, as well as universal and equitable access to health care. It heavily depends on the incentives and controls upon local governments. Those are related to public policies institutional design. SUS built up, between 1988 and 1993, a complex institutional structure through decisions are to be taken, in order to accomplish health policy goals and answer new problems posed by reform implementation. The article analyses the SUS´s institutional tools to induce local government actions committed to citizens welfare and health care quality. It concludes that although these mechanisms are not yet in their full operation, the challenge consists more in making them work better than replacing them by any other else. Key words Intergovernmental relations, Local governments, Institutions
1 Departamento de Antropologia Política e Filosofia/Unesp, Faculdade de Ciências e Letras de Araraquara, Universidade Estadual Júlio de Mesquita Filho. Rodovia Araraquara Jaú s/no , 14800-901, Araraquara SP. [e-mail]

Resumo O trabalho argumenta que os governos locais já assumiram a gestão da atenção básica à saúde no Brasil. No entanto, não há qualquer garantia intrínseca à gestão local que promova responsabilidade, eficiência, acesso universal e patamares eqüitativos de atenção à saúde. A qualidade da ação dos governos depende, em grande medida, dos incentivos e controles a que estes estão submetidos. Estes últimos, por sua vez, derivam do desenho institucional das políticas. O SUS construiu,