Dependência, neoliberalismo e as relações público-privadas na saúde: para uma economia política da privatização da gestão do SUS

Abstract

This thesis is the result of theoretical research aimed at a critical analysis of privatization processes in the Unified Health System (SUS). The work was based on a bibliographical review of articles and theses in the field of the political economy of health, related to the expansion of processes of privatization and financialization of social policies, evidenced through research with secondary data. To this end, we focused on the debate on outsourcing the management of public health services, understood as a “non-classical privatization”, but no less consequential. The main objectives of the thesis were twofold: i) to analyse the privatization of public health management in Brazil in dialogue with elements of the Marxist Theory of Dependency (TMD) and the Political Economy of Health (EPS); ii) to debate trends and impasses in non-classical processes of privatization of the SUS that involve outsourcing the management of public health services. We analyze this process from the perspective of a critique of political economy, which translates into a political economy of health. In addition, we emphasize the understanding that the analysis of public-private relations in health is part of a broader analysis of capitalist development in Brazil's economic and social formation, and of the particularities of a hybrid health system in a dependent State, where the State category has explanatory centrality. To this end, we work together with the categories State, dependency, public fund, financialization, neoliberalism and public-private relations to critically debate privatization processes within SUS, which are considered non-classical and involve processes of commercialization of the management of public health services. For a more in-depth discussion of the determinants of dependency and its historical process, we aligned ourselves with the Marxist Theory of Dependency in order to unveil the particularities of the Brazilian State and how the expanded reproduction of capital has been taking place in the health sector, particularly in “neoliberal dependency”. We also seek to minimize the polysemic traits of the category neoliberalism, with explicit theoretical adherence to Marxist interpretations of this category, in the very sense that we defend the hypothesis that neoliberalism does not represent a mere reissue of classical liberalism, and explains the power of this political project that refunctionalizes the State in contemporary times. Some of the conclusions presented point to the fact that this project permanently strains the State, seeking to refunctionalize it in favor of strengthening the private health services sector by de-funding the SUS in the provision of its own services. This is a project that transforms the public-private concept and imposes a certain mode of social reproduction, in a universe of new processes of individualization, privatization and complete aversion to the redistribution of wealth through universalizing social policies, such as SUS, particularly from the 1990s onwards in Brazil. We are therefore talking about a hegemonic project, on a global scale, but which specifically affects the peripheral countries. Finally, we stress our understanding that it is through the tools of the political economy of health and the analysis of “neoliberal dependency” that we can structure Marxist criticism in the field of Collective Health, as well as the struggle for the deprivatization of SUS.