出版社：Escola Brasileira de Administração Pública e de Empresas da Fundação Getulio Vargas
摘要：Numa economia de mercado, as questões econômicas básicas de produção e distribuição de serviços médicos são resolvidas racionalmente, ao nível individual. Por outro lado, os fracassos das decisões privadas individuais são, frequentemente, mencionadas para apoiar políticas de iniciativas governamentais.
其他摘要：The purpose of this paper is to discuss how a purely private market might allocate medical care resources. In the market system, the demand for services and goods is equated with available supply by movements in price. However, the hea1th services industry has some characteristics which distinguish it from those industries more directly affected by market forces. Therefore, the market's failure is often cited to support State intervention in the production and distribution of health services. However, it is worth pointing out that the market's system failure does not necessarily imply that State intervention is desirable. There are many ways that the State can intervene in the private market for medical care. The principal institutional feature of he Brazilian health service is the private ownership of most health care agencies. Therefore, health is provided largely by private hospitals and the bulk of Inamps funds from contributions of the insured population go for hospital inpatient care provided by private hospitals. The magnitude of federal government involvement in health care as a major purchaser of health care services needs to be investigated by society as a whole. Because most of medical care services are provided by private hospitals concentrated in the major urban areas, hea1th resources continue to accumulate in wealthier areas. The effect of supply and distribution of health care resources on utilization seems not to be a great concern to our policymakers. More than 50 per cent of all cases treated in Brazilian hospitals is classified in the specialty of general medicine and the private sector is the major provider of services in this medical specialty. On the other hand, it has been argued that the health needs of our population are largely of a simple nature. This fact can lead where to postulate that the private sector is providing more "hotel services" than medical treatment. Consequently, hey are highly profitable. Further, it has been stated that in terms of medicai care, he Brazilian social security scheme up to now has privileged fundamentalIy the interests of capital investment in the health sector and not the interests of the social security beneficiaries. Health care planning should become dominated by the needs of the population rather than the service. This implies a redirection of Inamps policies with a greater participation of consumers in decisions than the producers of health care.
