‘Dark’, ‘hasty’ and ‘unconstitutional’: experts analyze the decree to privatize SUS health posts | Science and health

Experts heard by G1 showed concern and caution with the text published on Tuesday (27), which was understood as an essay for the privatization of SUS. In notes from the Ministry of Economy and Presidency, the federal government stressed that “the measure does not represent any prior decision.” The Ministry of Health did not comment on the matter.

Check out 5 questions and answers below for expert analysis on the topic:

1. What does the decree say?
2. What does it mean in practice?
3. Are there already alliances with the private sector in the SUS?
4. Can the SUS be privatized?
5. Why are UBS important?

Decree No. 10.530 / 2020 provides for “the qualification of the promotion policy of the primary health care sector within the scope of the Investment Alliances Program of the Presidency of the Republic, with the purpose of preparing studies on alternative alliances with the private sector ”(vSee below and the full text of the text at the end of this article.).

The text provides, within the scope of the Investment Alliances Program (PPI), the “preparation of studies of alternative alliances with the private sector” to build, modernize and operate health posts (known within the SUS as Basic Health Units, the UBS).

The document is signed by President Jair Bolsonaro and the Minister of Economy, Paulo Guedes. There is no signature of any member of the Ministry of Health.

In a note, the General Secretariat of the Presidency of the Republic said that the studies should indicate “the feasibility (or infeasibility) of the concrete application” of the alternatives suggested by the studies.

2. What does it mean in practice?

In the opinion of the health and law researcher Daniel Dourado, from USP, the government text is Dark.

“It is a very strange decree, very dark, the wording is very bad. It’s very difficult, because you don’t understand what he’s talking about, ”says Dourado, while recalling that the government’s PPI program“ is a program that basically deals with concessions and privatizations ”.

For Dourado, what worries him is the following:

“The point is that There are already models of public-private partnerships in health. (see details below), It’s not about that. What we assume is that they are trying to find another model. What worries me about this decree is that it will not deal with something that already exists. If this were the case, they would not need to make a decree saying that they will study new business models ”, he recalls.

Public health specialist Lígia Bahía, from the Federal University of Rio de Janeiro (UFRJ), described the decree as “hasty” and considered “strange” the fact that the health area had not been heard (see video below).

“This investment, this arrival of the Ministry of Economy to health is something extremely worrying, it is a disaster. Minister Paulo Guedes does not understand anything about health,” Bahia said.

The president of the National Health Council (CNS), Fernando Pigatto, understood the decree as a way to withdraw the rights of the population. Pigatto said that the decree will be evaluated by the CNS’s Technical Chamber of Primary Care (CTAB), which must issue a formal opinion on the text and take the necessary legal measures.

“We need to strengthen the SUS against any type of privatization and withdrawal of rights” – Fernando Pigatto, president of CNS

3. Can the private sector have alliances with the SUS?

Yes, the private sector can have alliances with the SUS. There are three possible types, explains researcher Ana Maria Malik, coordinator of FGV Saúde, Fundação Getúlio Vargas in São Paulo, specialist in public-private partnerships (PPP) in health:

1. The facts with Social health organizations (OSS), philanthropic institutions of the third sector nonprofit and they are responsible for managing SUS services throughout the country, working in partnership with governments. Most of the health posts in São Paulo, for example, are managed by an OSS.
2. The facts by Proadi (Support Program for the Institutional Development of the Unified Health System), in which 5 Brazilian hospitals of excellence provide services to the SUS, from educational projects to highly complex health care, such as transplants (although, according to Malik, these have been done less frequently). In return, hospitals receive tax free.
3. Those carried out in PPP, such as the Hospital do Subúrbio, in Salvador. In the case of Bahía, specifically, the company involved is responsible for equipping, furnishing and operating the hospital unit, including the medical services provided. The costs are paid by the state of Bahia and the service to the people remains free.

In the case of OSS, the legislation that allows alliances is from 1998. The issue was judged by the Federal Supreme Court (STF) in 2015, which allowed private entities known as social organizations to provide public services in the areas of teaching, research scientific, technological development, environment, culture and health.

4. Can the SUS be privatized?

According to Daniel Dourado, from USP, only if a new constitution is made. This is because the right to health is guaranteed in the 1988 Constitution and, since it is a stone clause, it cannot be changed by a constitutional amendment.

Dourado explains that, although it is foreseen in the Constitution that it is possible for private companies to obtain public service concessions and benefit from them – as is the case with road concessions, for example – this it can’t be done in health.

“When talking about the business model and privatization and concession, one thing has to be very clear: having the logic of private initiative within SUS cannot, it is unconstitutional” – Daniel Dourado, USP researcher in health and law

“Health is a social right. The SUS is there – the right to health is directly linked to SUS by the Constitution itself. If the SUS is changed to insert a private logic, this has a great chance of falling into something unconstitutional, ”he explains.

“If he [o decreto] It takes away part of the population’s access to health – who knows which paths, because they don’t make it clear – that cannot be done. The Constitution does not allow it and cannot be modified in this way. Any deviation from this direction can be part of a stony clause. You cannot reform the Constitution to remove or diminish rights and guarantees ”, explains the researcher.

5. Why are UBS important?

They are to preferential entry port no SUS, where the so-called primary or basic health care is provided.

According to the Ministry of Health itself, the objective of the posts is “to attend to up to 80% of the population’s health problems, without the need for referral to other services, such as emergencies and hospitals.”

The researcher Ana Maria Malik, from FGV, recalls that the basic network plays a fundamental role in the organization of assistance.

“You have to be very careful to try to avoid this [a parceria com o setor privado] satisfy different interests, in addition to organizing the health system “- Ana Maria Malik, from FGV

The three principles of primary care are the same as those of SUS: universality, a capital It’s in integrity. This means that:

1. access to these services must be universal;
2. the care offered must recognize the differences between people and it is prohibited to exclude someone because of age, sex, color, socioeconomic status, education and other conditions;
3. Services must meet the needs of the population in the fields of health care, health promotion and maintenance, disease prevention, healing, rehabilitation, harm reduction and palliative care.

The special secretary of PPI, Martha Seillier, declared that “we know that in several Brazilian municipalities there is a lack of a UBS structure. Unfortunately, of the works contracted in the past, many of them have not been completed.”

“That is why we believe that the PPP model can contribute a lot to this UBS system in Brazil, so that we can, through alliances with private companies, complete these projects, build new UBS and equip them. And have an excellent service for the population, “he said.

THE G1 He sought both the Ministry of Health and the Ministry of Economy to know how many and which would be and where the unfinished UBS would be located, but did not receive a response until the publication of this report.

See the full text of the decree:

DECREE N ° 10.530, OF OCTOBER 26, 2020

It provides for the qualification of the policy for the promotion of the primary health care sector within the scope of the Investment Alliances Program of the Presidency of the Republic, with the purpose of preparing studies on alternative alliances with the private sector.

THE PRESIDENT OF THE REPUBLIC, in the exercise of the powers conferred by art. 84, section, sections IV and VI, section “a”, of the Constitution, and taking into account the provisions of art. 4 of Law No. 13,334, of September 13, 2016, and Resolution No. 95, of November 19, 2019, of the Council for the Investment Alliances Program of the Presidency of the Republic,

Art. 1 The promotion policy of the primary health care sector is classified, within the scope of the Investment Alliances Program of the Presidency of the Republic, with the purpose of preparing studies on alternative alliances with the private sector for construction , the modernization and operation of Basic Health Units in the States, Federal District and Municipalities.

Sole paragraph. The studies to which the caput refers will have the initial purpose of structuring pilot projects, the selection of which will be established in an act of the Special Secretariat of the Investment Associations Program of the Ministry of Economy.

Art. 2 This Decree enters into force on the date of its publication.

Brasilia, October 26, 2020; 199 of the Independence and 132 of the Republic.