Privatizações na saúde: a atuação do Instituto Coalizão Saúde (ICOS) e as mudanças no sistema de saúde brasileiro

Abstract

There is an expansion of public-private relations in healthcare, which permeate public policies and the healthcare system in Brazil. Its context of economic, political, cultural and social transformations, with the neoliberal regime and the crises, impacted labor relations, management and regulation, and pointed to other forms of domination. This paper aims to study Instituto Coalizão Saúde (Icos) demonstrating its organization and agenda between 2015 and 2020, configuring it as a Private Hegemony Apparatus (APH), as well as the analysis of the context of changes in Brazilian healthcare policies. This was a documental and bibliographic research study. The documents published by Icos between 2015 and 2020 were analyzed, and the main theorists studied were Donnangelo (1976), Braga (2018), Bahia (2018, 2019, 2020, 2021), Sodré (2020), Harvey (2005, 2020 ), Chamayou (2020), Prado (2015, 2020), Choonara (2018), Marx (1994), Fontes (2012, 2020) and Hoeveler (2019). From the document analysis, it was possible to verify that the main themes addressed by Icos encompassed management, training and work in healthcare, as well as research and regulation, whose proposals meet the technical changes in healthcare work, the formation of leaders for managing and patients responsible for their care, as well as changes in regulation in order to prioritize public-private relationships or the domain of private over public, mainly through management contracts but also, through changes in healthcare payments, and the appropriation of data by business groups. Another important element is the philanthropic way in which they are inserted in public policies or in social and community groups, but whose funding is public. Icos’ performance took place in the restricted State through changes in legislation and public policies, and in Civil Society with professional training, with social responsibility actions to build consensus. The research on the Instituto Coalizão Saúde contributed to understanding how the ruling classes organize themselves and build propositions, claiming their insertion or capture of public healthcare actions, as well as what the political-economic trends of the Brazilian State in the relationship with companies, corporations and governments are in the dynamics of contemporary capitalism. The Private Apparatuses of Hegemony assume a perspective of education and/or organization of the ruling classes or even of the lower classes, in the class struggle dynamics. And there are several organic intellectuals who take the dominant position, which, in this case, maintain ties and reproduce the international circuit of imperialist interests in the healthcare area in Brazil, fulfilling their role of articulation and mediation with the public sector. The pandemic period made explicit some of the trends observed in relation to living and working conditions, as well as the need to reorganize the ruling classes before the crises emerging.