The main objective of this work is to understand if the Institute of the Pact,
established by the Health Pact in 2006, promotes more cooperative and supportive
behavior among federal entities involved in the compromise of public health policies,
as well as, if it induces the proper allocation of functions, planning and organization
of regionalized systems, and, if institutionality is guaranteed, to intergovernmental
agreements, public health policies are necessary. In order to do so, it is intended to
use as inspiration the Neo-institutional theoretical-methodological reference,
specifically the rational choice and, within it, the Asymmetric Bargaining Theory, to
investigate the problem. We assume that the fact that health service provision is
conditional on the need for universal, equitable and integral care to Brazilian citizens
with scarcity of resources and infrastructure, requires articulation between
municipalities, state and union, in this way the articulation is far from being trivial and
therefore the need for rules that establish parameters for the affirmation of
intergovernmental pacts. It is observed that the institutional arrangement established
by the SUS does not allow credibility in the commitments assumed by the federated
entities and that the mechanisms used do not allow convergence of the strategies of
the actors to the condition of cooperation. The pact institute does not create
conditions to stabilize competing positions and internalize externalities, as well as
contain the risk and uncertainties in the agreement, so it is insufficient in a context of
conflicting interests with asymmetric information, power and resources and greater
flexibility of the design regional level to alleviate the distributive struggle between
municipalities offering and demanding medium and high complexity health services.
These rules maintain the conditions for maximizing the individual interests of the
disbursing municipalities and in asymmetric information conditions and tendencies in
the political arena do not allow to establish levels of credibility of commitment
between federated entities and added to exogenous factors to the process of
agreement maintains attitudes that hurt the principles of universality, equities and
integrality established by the Brazilian citizen constitution.
|
