THE CHOICE OF PUBLIC-PRIVATE PARTNERSHIP FOR MANAGEMENT HOSPITALAR NA
BAHIA: Actors, interests and strategies
Key-words: Unified Health System; Public-Private Partnership; Hospital management; Public
Policy Cycle
ABSTRACT
The Unified Health System, the result of a broad process of struggle, led by the politicalideological
conception of the Movement for Brazilian Sanitary Reform has been opposed by
the hegemonic political forces that defended the broad participation of the private sector in
management, attention and financing of health. In this perennial context of disputes, new
management models presented themselves as capable of solving old problems of health
management, such as people management, infrastructure, and propagating themselves as
having innovative management modes. One of these models, the Public-Private Partnership
(PPP), has been promoted by the World Bank through consultancies in several countries
around the world and in Brazil has been gaining space in the health sector. In the context of
chronic crisis, characterized by the low capacity to finance new structures, associated with the
restrictions of the fiscal responsibility law, the State of Bahia extended its scope of use
management models and adhered to the PPP model for hospital management. In view of this,
the question that guided the research was why and how was the PPP model for hospital
management adopted in SUS? With the purpose of analyzing the processes of decision
making and incorporation of this model for hospital management in Bahia. The detailing of
the plot unfolded in the decision-making process was based on the theoretical framework
constituted by Public Policy Cycle and Power Games Theory; in bibliographical review and;
interviews with key players in the decision-making process. The research pointed out the
difficulties of hospital management in health, discussed the advantages and disadvantages of
management models to address these problems and concluded that determinants not only
financial, but political and ideological marked the decision process about the model in the
State, which had as a promoter and consultant, for design and feasibility of the project, the
right arm of the World Bank, the International Finance Corporation.