Contratos de gestão na área de saúde como instrumento de governança pública: um estudo à luz da teoria dos custos de transação

Abstract

The present work aims to evaluate governance of management contracts made between a Municipality and Social Health Organizations (OSS) for the management, operation and execution of health actions and services. To this end, we opted for the elaboration and application of the analysis framework proposed by Trajano Quinhões (2008) in a sample composed of four management contracts executed between the Municipality and Social Health Organizations in the period between 2009 and 2023, namely: “Pró-Saúde Associação Beneficente de Assistência Social e Hospitalar (PróSaúde)” and “Instituto Nacional de Ciências da Saúde (INCS)”. The factors that motivated this research are the theoretical gap and the absence of specific models or well-established parameters for evaluation, as well as for analysis of governance and transaction costs of management contracts. The use of the proposed adapted framework proved to be valid for the situation examined, which suggests its viability for replication in other Municipalities for evaluation and analysis of their health management contracts. It was verified that contracting through management contracts for health services provision proved to be efficient in the case studied (Pinhais Municipality), with low levels of behavioral and environmental uncertainty. Furthermore, it was found that in the Municipality’s decision, in 2009, to implement the OSS governance model, including its maintenance in subsequent years, there is a difficulty in measuring the cost-benefit and presenting a comparison between the transaction costs of the OS model and direct administration, given that this has never been a reality in the Municipality, that is, there are no well-defined parameters to be compared. Thus, the choice of management system occurs predominantly considering its impacts on the effectiveness of the participants and on the process itself, rather than being based exclusively on the costs involved in the transaction.