Proposals from the World Bank for Health Sector Reform in Brazil in 2017

Abstract

This essay aimed to analyze the recommendations for health sector published by the World Bank Group (WB) in the report 'A Fair Adjustment: Analysis of the Efficiency and Equity of Public Expenditure in Brazil', in November 2017. The theme is current and relevant to debate the implications for the Brazilian National Health System (SUS). A brief contextualization on globalization and the influence of international financing institutions on peripheral capitalism is presented. It was sought to situate the previous studies that analyzed the WB proposals to the Brazilian health sector to understand the direction of these recommendations. The analysis of the last Report shows that the WB has kept the line guided by neoliberal promarket assumptions that convert health into consumer goods, arguing that it is possible to produce more with the same
costs in a more efficient management and provision with greater participation of the private sector. However, the document
does not deepen the debate about SUS agreements with private hospitals, nor does it present efficiency indicators, disregarding Brazilian regional heterogeneities. Another perspective maintained by the WB was the recommendation to limit the State's responsibility to the role of regulator and reiterates the need for integration between systems. Finally, it points out that the tax exemption of expenses incurred with private health expenditure increases health inequities since they are less progressive, an aspect not highlighted in previous Reports.