000			02836nam a2200205 4500
001			19891
090			_a19891
100			_a20050614u y0pory50 ba
101			_apor
200			_aDecentralization and privatization in portuguese health reforms
300			_aVolume temático
330			_aThe Portuguese National Health Service (SNS), a universal, centralized and public owned health care system, exhibits an extraordinary record of equalization in the access to health care and health gains in the late thirty years. However, the most recent history of the Portuguese health reform is pervaded by the influence of decentralization and privatization. Decentralization has been present in the system design since the 1976 Constitution, at least in theory. Private ownership of health care suppliers and out-of-pocket expenditures, on the financing side, both have a long tradition of relevance in the NHS mix of services. the initial aim of this study was to demonstrate expected parallelism between health reforms and public administration reforms, where a common pattern of joint decentralization and privatization was observed in many countries. Observers would be tempted to consider these two movements as common signs of new public management (NPM) developments. They have common objectives, are established around the core concepts of gains in effectiveness, efficiency, equity and quality of public services, through improved accountability. However, in practice, in Portugal, each movement was developed in a totally separated way. Besides those rooted in the NPM theory, there are few visible signs of association between decentralization and privatization. Decentralization in the Portuguese SNS, was never intended to be followed by a privatization movement; it was seen merely as a public administration tool. Private management of health services, as stated in the most recent SNS legislation, was never intended to have decentralization as a condition or as a consequence. Paradoxically, in the Portuguese context, it has led invariably to centralized control. While presented as separate instruments for a common purpose, the association between decentralization and privatization still lacks a convincing demonstration. Many common health care management stereotypes remain to be checked out if we want to look for eventual associations between these two organizational tools.
461			_vN.4 _d2004 _pp.7-20 _tRevista Portuguesa de Saúde Pública _cLisboa
606			_aSECTOR DA SAÚDE SAÚDE PÚBLICA DESCENTRALIZAÇÃO PRIVATIZAÇÃO REFORMA QUALIDADE SERVIÇOS DE SAÚDE _917786
700			_aCAMPOS _bAntónio Correia de _9325796
852			_jP.240