Regulação dos cuidados de saúde nos Estados Unidos: complexidade, confrontação e compromisso

  • Robert I. Field Department of Health Management and Policy, Drexel University Dornsife School of Public Health; Philadelphia, PA, USA

Resumo

Os Estados Unidos têm o maior sistema de saúde do mundo, e a regulação que o supervisiona é imenso e complicado. A estrutura federal do Governo americano que divide os poderes entre o Governo federal e os Estados, potencia essa complexidade. Maior complexidade é acrescentada pela supervisão privada, incluindo a autorregulação de importantes aspetos do sistema. Esta teia de autoridades regulatórias cria um terreno fértil para a competição e confrontação entre várias entidades regulatórias, tal como está refletido na reestruturação regulatória para sectores chave. Os médicos são regulados por leis estatais de licenciamento, mas a profissão detém uma influência considerável sobre esse processo, tal como sobre outros aspetos da formação e prática médica. A regulação hospitalar é dominada por uma organização privada controlada pela indústria. Os seguros de saúde são primordialmente regulados pelos Estados. Medicamentos e dispositivos médicos são primordialmente regulados pelo Governo federal. Apesar deste sub-contexto de complexidade e competição, o sistema de saúde pode ser visto como uma simbiose na qual os sectores privado e público se juntam numa colaboração implícita que tem permitido que o sistema de saúde americano tenha crescido e florescido. 

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Publicado
2017-06-30
Secção
Artigos Originais