Resumo em Inglês (abstract)

The objective of this Doctoral Thesis was to study the effects of the economic crisis and the health crisis in the health system in Brazil, having as its object the repercussions in the public and private sectors, as well as to subsidize the reflection and the debate on the dynamism of the companies of plans and insurance, the interfaces between the public and the private in health, the ideological conception that guides health policies in the country and the aspects that bring us closer or further away from the principle of universality of the SUS. The country has a universal and public health system and a strong presence of the private sector, which operates both in the provision of health care through the contracting of services by the SUS, and by health insurance companies, which cover about 25% of the population. With the economic crisis installed in Brazil since 2014, the private health market showed a slight reduction in the number of consumers. Still, the companies managed to increase revenues. Six studies were carried out dealing with themes involving economic crisis; health crisis; public and private spending on health; performance of health plan companies in Brazil and the USA; business strategies and government policies for the preservation, expansion and diversification of the private health market; public subsidies and tax expenditure on health plans; offer and use of services in the previous period and after the economic and health crisis; inequalities between public and private in health; and analyzes of the Brazilian health system. Extensive bibliographic and documental research was carried out, as well as the analysis of a wide range of data and information. From the emergence of the private health sector to the current times of economic crisis, proposals and strategies have been highlighted that seek to create new arrangements in order to diversify the market and leverage the sale of health plans and insurance to the population. The study highlighted the historic adoption of measures for the preservation and expansion of the private health sector in the country and highlights how this process is consolidated with government support and in dissonance with the principles and bases established for the health system in Brazil. The economic crisis affected the public health sector with the constraint of resources. However, it was found that the private health market continued to expand during periods of economic crisis. This phenomenon had as a background the strong protagonism and dynamism of health insurance companies and their representative entities, as well as strategies that involved government measures that promoted both the preservation of the private health sector and its expansion, a government incentive that contributes to the deterioration of public services. The private sector is highly adaptable to different economic cycles, including during the health crisis triggered by the Covid-19 pandemic. The analysis of the Brazilian health system supported the construction of the thesis called “privatizing universalism”. A synthesis that seeks to express the movement towards universalization of the private component in health, encompassing both the historical inequality between public and private health in the country, as well as more recent aspects and trends in the face of the economic and health crisis. The political-ideological guidelines that guide health policies in Brazil, the reduction of financial resources with the consequent scrapping of the SUS and the "SUStaination" of the private health market, through the granting of public subsidies to the private health sector, conform what can be called “triad of inequality”, which was aggravated in the context of the economic and health crisis. The reflections developed during the investigation suggest the need to
establish and reinforce spaces for democratic debate, as well as to expand the scope of action, so that the health movement has as much political influence as health entrepreneurs, establishing energetic and organized action in favor of guarantee of health and citizenship rights, in order to promote debate in society about the pertinence of policies that drive the rise of foreign capital in health to the detriment of the universal public system.