Velhos dilemas no provimento de bens e serviços de saúde: uma comparação dos casos canadense, inglês e americano.

Abstract

This paper systematises some aspects related to the consequences of the institutional health system in the financing and delivery of health care services. The analysis is based on empirical evidences from United States, Canada and United Kingdom. The focus of this work is on the analysis of the impacts of the incentives that result from the contracts established between health care market agents in the management efficiency of the health care services. The empirical evidence suggests that, in general, in public systems the incentives that guarantee the rationalisation of the use of health care services are not incorporated in the designed contracts. This fact allows the emerge of typical moral hazard problems that exists in the relationship between providers and financing agents and between patients and financing agents (that can be insurance companies or government). In opposition, in these systems the control of the expenditure is reached by the government budget constraint and regulatory mechanisms that guarantee some advantages to the government in the process of determination of providers reimbursement.