Author: Demétrio Weber and Letícia Lins

Source: O Globo, 13/07/2009

Under strong resistance from the government, including PT parliamentarians, the creation of state foundations under private law could serve to modernize the management model of 2 of the 5 public hospitals linked to the Unified Health System (SUS). The estimate is from the Ministry of Health, which, despite the criticisms of unions to the project, continues to believe that states and municipalities will adhere to the new model.

The ministry reports that five states already have legislation that allows hospitals to operate as private-law foundations: Rio de Janeiro, Acre, Bahia, Pernambuco and Sergipe.

The state foundation gives the manager freedom to hire employees under the CLT (Consolidation of Labor Laws) regime, charge for better performance and dismiss in case of non-compliance with quality goals.

Last week, advisers to the Minister of Health, José Gomes Temporão, even announced, at a meeting at the National Health Council, that the ministry would give up on approving the proposal in the National Congress.

Union leaders celebrated. But Temporão warned that he keeps fighting for the project, although he recognizes the difficulty of approving it.
- We have no alternative but to persevere in the search for a new model. The current model is inefficient, anachronistic and from the last century.
It is necessary to create goals, contracts, allow payment of more adequate salaries and more qualified professionals - said Temporão.

Professor Pedro Barbosa, a researcher at the National School of Public Health of the Oswaldo Cruz Foundation (Fiocruz), warns that the creation of foundations is not about privatizing the health system. He says there is a lack of clarity in the debate over the government's complementary bill, whose vote is stuck in the House. "Confusion has generated resistance".

The government's proposal foresees the creation of public foundations under private law to manage activities in several areas, such as health, social assistance and culture. Unlike what happens in direct administration, private law foundations can hire personnel by CLT (through a competition), establish management goals and dismiss employees (after administrative process).

- The fact that it is a private right does not, under any circumstances, mean privatization. The constitutional rule allows the existence of state-owned companies, such as Petrobras and BNDES (National Bank for Economic and Social Development). Private law means administrative flexibility, without eliminating public property - says Barbosa.           

- Therein lies much of the confusion that has generated resistance, as if the government were making some privatization movement.

According to the researcher, large public hospitals circumvent the bureaucracy of the federal administration. They do this through support foundations. Thus, they are able to hire temporary professionals or buy equipment, sems and submit to deadlines and legal requirements that, although intended to curb deviations, jam the public machinery.

-The focus should be on the quality of service, the volume of production, the citizen as a customer - says Barbosa, saying that Fiocruz resorted to a support foundation to hire temporary workers and increase the production of yellow fever against last year.

The president of the National Health Council, Francisco Batista, agrees that it is necessary to improve the management of hospitals. But it attacks the proposal: - It is absolutely unconstitutional.

Rather than counteracting the most serious management problems that exist, it strengthens those problems. Health services suffer greatly from political appointments in command posts. We already have information from political groups vying for the direction of foundations. Today, these people are facing legal limits and have to submit to bids.

But the initiative to create entities that would aim to modernize the management of the public health network does not face difficulties only at the federal level. In Pernambuco, the state government was able to pass similar legislation, but so far it has not yet been able to put it into practice, because the law is being challenged in court by entities such as the Union of Doctors of Pernambuco and the Union of State Servers of Cheers.

There are two Pernambuco laws that have already been approved. Complementary Law 126, of August 29, 2008, authorizes the creation of foundations to manage state hospitals. Ordinary Law 13.537, of September 12, 2008, creates the State Foundation for Hospital Assistance Josué de Castro - a public foundation with legal personality under private law, non-profit.

Initially, Josué de Castro would manage the Hospital da Restauração, the largest emergency built by the state, today managed jointly with SUS. The Hospital da Restauração has 3 thousand servers and 723 beds. Records 1,3 hospitalizations monthly, with 70 surgeries.

In addition, there are 10 emergency calls and 13 outpatient visits per month. The structure, however, proves to be insufficient for the
excess demand. For days, HR has patients spread out on stretchers, on chairs and even on the floor.

The lawyer for the two unions, Mauro Feitosa, filed Complementar 126's unconstitutionality lawsuit with the Pernambuco Court of Justice. According to the lawyer, the state constitution determines that health must be provided directly
by the state, complemented by private entities (clinics and hospitals under SUS agreements) and supplemented by (private) health plans
Cheers.

Both laws were preceded by a series of protests that included a nine-day strike by state health workers. The union president, Perpétua Rodrigues, says what the workers' fear is: - The workers fear being governed by the celetist regime. Currently they are statutory, which guarantees them greater stability.

Source: O Globo, 13/7/09