Health Care Models in Brazil: Challenges and Prospects
Health Care Models: Challenges and Prospects
The model of care in a given society involves the organization of health care actions, including technological and service issues. It is a form of organization and coordination among various physical, technological, and human resources to address and solve the health problems of a community.
Historically Built Models in Brazil
Republic: Health workers, technicians, and other health guards organized campaigns to fight epidemics (yellow fever, smallpox, and plague) that ravaged Brazil in the early 20th century.
1930s: Programs were created for prenatal care, immunization, child care, tuberculosis, leprosy, sexually transmitted diseases, and others.
Scientific Medicine/Biomedicine: This model focuses on assisting with individual and organic diseases, centered in hospitals, medical specialties, and intensive use of technology. This model structured preventive medical assistance in the 1940s and expanded in the 1950s, also directing the organization of state and university hospitals.
Crisis and Criticism of the Hegemonic Model
Biomedicine’s limits are emphasized by the fact that the more expensive it becomes, the greater the difficulty of access for people with poor economic conditions, whose demands for health services are the greatest. This is called unequal distribution of benefits and health care provision.
From a technological standpoint, there was a predominance in the use of so-called hard technologies (dependent on equipment) to the detriment of light technologies (professional-patient relationship), leading to a push for diagnostic tests and images, but not necessarily care for patients’ suffering. However, biomedicine has become the hegemonic model in the provision of health services in Brazil and many countries worldwide.
Alternative Proposals
- Rationalization of technology use in medical care and effective management: The most widespread was primary care or community medicine.
- Health Reform Movement: This culminated in the VIII National Health Conference in 1986. The guidelines of the Conference took shape in the 1988 Constitution and the Organic Law of Health (8080/90) and turned into goals to be pursued by a reorganization of the National Health System (SUS):
- Universal Service: Every citizen has the right to health care, and the state has a duty to promote it.
- Integral Health Care: Every citizen should be understood in their biological, psychological, and social aspects. Teams of professionals and network services should be articulated to ensure the provision of interventions in health promotion, disease prevention, cure and control of injuries, and patient rehabilitation. The hierarchical service network should offer technologies that complement one another in varying degrees of complexity, according to the needs of users. In a political dimension, government and societal sectors must be articulated in intersectoral policies that promote health and prevent injuries.
- Equity: The benefits of the policy must be distributed to reduce inequalities, promoting the health of those with greater needs.
- Social Control: This organization at various levels must be addressed, monitored, and evaluated to fulfill its goals by control structures in society. The 8142 Law of 1990 guarantees the existence of health councils at the municipal, state, and national levels. Society can and should participate in decision-making at local, regional, and national levels to exercise social control. This control is also exercised daily by citizens to use and evaluate services and political actions that interfere with the quality of life.
- Alternatives to overhaul health services:
- The notion of territory is not comprised only geographically but as a ground-process where society is structured and reproduces life, organized culture, and living history.
- The definition of a health problem is constructed more broadly than illnesses through a systematic analysis of the causes and consequences of situations that affect the health of the population in the planning of activities and evaluating their impact on identified problems.
- With regional and micro-regional planning, strategies are set to guide the proposed redistribution of resources aimed at greater equity.
- The reorganization of health practices emphasizes an interdisciplinary approach in which epidemiology, social sciences, clinical medicine, health education, and the housing sector, among other skills, can articulate in understanding health and disease in their individual and collective aspects.
- Extension workers’ perceptions about users, understood in their broadest biological, psychological, and social aspects, result in developing actions that articulate health promotion, prevention of injuries, healing and recovery of individuals or communities, and patient health surveillance (in a holistic approach).
- The revision of classical concepts of a hierarchy of services, based on the recognition of the complexity of primary care in its dealings with the public and their health problems.
- The recognition that the problems presented by populations, especially in urban areas, require a multidisciplinary approach and networking (in the full network of services).
- The articulation of the health sector with other sectors of government in formulating policies for healthy cities (intersectionality).
- Democratized management, in view of flattening organizational charts and constructing collective spaces, identified as alternatives to enable greater participation of workers and the population.