The public-private conflict in SUS: specialized outpatient care in Paraná

Abstract

The fundamental conflict in access to health services, present in capitalist societies, social right or commodity, is also expressed in SUS. This research analyzed the public-private relationship in the provision of specialized ambulatorial services by SUS in the state of Paraná from 1995 to 2015, in comparison with the national reality. A descriptive study was carried out with selected procedures, with data collected in the Ambulatorial Information System (SIA) through the Datasus Tabnet Online platform in the years 1995, 1999, 2003, 2007, 2011 and 2015. The results demonstrate that specialized ambulatorial care, secondary and tertiary, has expanded over the past two decades, following the expansion of SUS. The percentage of private participation is, in general, minority in the services of medium complexity and majority in the services of high complexity, being that in Paraná the degree of privatization is considerably higher than in the national scope. Thus, differently from what is constitutionally recommended, in various services and areas of the SUS, the public assumes the role of complementing the private. The possible impacts of the internal privatization of SUS on its limits on constituting itself as a universal, integral and equal system are discussed.