A saúde é direito de todos e dever do Estado, conforme dispõe o art. 196 da Constituição Federal de 1988, garantido mediante políticas sociais e econômicas que visem à redução do risco de doença e de outros agravos e ao acesso universal e igualitário às ações e serviços para sua promoção, proteção e recuperação. O meio tradicional pelo qual os Estados democráticos promovem a efetivação dos direitos fundamentais, em especial os de segunda dimensão, como é o caso do direito à saúde, são as políticas públicas. No Brasil, o embrião das políticas de saúde hoje existente foi formulado na Constituição de 1988 e regulamentado pela lei 8.080/90, baseada no acesso universal, equânime e integral aos serviços de saúde. Esse modelo, entretanto, sofreu sensível alteração em 1995 com o Plano Diretor de Reforma do Estado. O plano privilegiava uma atuação estruturada em funções estatais de fomento e parcerias com o setor privado. A presente pesquisa busca avaliar de que forma o modelo das organizações sociais, criado em 1998 pela lei federal nº 9.637/98 se acomodou na estrutura do SUS e abordar alguns desafios que se tornaram evidentes com a sua implementação, especialmente no que tange às escolha das entidades parceiras, ao controle dos recursos repassados e à inserção do modelo no âmbito das políticas de saúde. / Health is a human right and a State obligation according to article 196 of the Federal Constitution. Granted by social and economical policies conceived to reduce disease incidence and to foment universal and equal access to actions and services related to its promotion, protection and recovery. States traditionally see in public policies a way to enforce social rights, especially ones from second and third generation as the right to health. In Brazil, the core of health public policies was formulated by Federal Constitution and ruled by act nº 8.080/90, based on universal, equal and integral access to health care. This agenda, however, was altered in 1995 by the State Reform Plan. The Reform Plan supported structured action based on foment tools and public-private partnerships, included the social organizations desing. This research intends to assess how this design was adjusted in SUS structure, and address some challenges related to its implementation, especially those concerned to the partner selection process, accountability and its lacation on health public policies issues

published_or_final_version / Surveying / Master / Master of Science

This thesis is divided into two parts. Part I deals with demand management. For goods with no substitutes, under supply constraints, fairness considerations introduce negative externalities and lead to a market failure. One example of such a good with no substitutes is water. In case of a market failure, it is necessary to design coordination mechanisms called contracts which provide the right incentives for coordination. As “repetition can yield coordination”, the aim in this part is to design price based dynamic demand management contracts which, under supply constraints, mitigate the market failure. In these contracts, we consider complete information settings; and use the status quo proposition as a fairness criterion for designing them. The contracts are designed as almost noncooperative dynamic games, within the agency theory framework, where the agent (the consumer) is induced to consume at a specified consumption level based on the incentive mechanism offered by the principal (the producer). These contracts use the solution concept of sub-game perfect Nash equilibrium (SPNE) to compute the price (mal-incentive) that acts as a credible threat for deviation from the specified consumption level. In these contracts, unlike the dynamic contracts with asymmetric information, the penalty for deviation is proportional to the amount of deviation. First, we consider a two-period demand management contract for a single consumer satisfying the status quo proposition. Under the assumption that the gain to the consumer and the loss to the producer by deviation is small, the contract is shown to be economically efficient. It is shown that, in the finite horizon, a fair demand management contract cannot be efficient. The demand management contract is homeomorphic to finite horizon alternating bargaining model. In the finite horizon alternating bargaining model, there is a unique SPNE, in which the player who offers last is always at an advantageous position. In the two-period contract, the assumption considered attenuates the last mover advantage and leads to the efficiency. We have shown that one possible way to achieve efficiency, without the assumption, is to make the agents uncertain about the period of interaction. This possibility can be included in an infinite horizon contract. Hence, next, we design an infinite horizon contract for a single consumer. It is proved that this contract is economically efficient and provides revenue sufficiency. The sensitivity analysis of the contract shows that the discounting rate measures the aversion to conservation characteristics of the consumer. The analysis of the contract shows that a sufficiently time-patient consumer is not penalized for the deviation, as the consumer himself is aware of conservation requirements. This result is similar to the results for the present-biased preferences in behavioral economics. Lastly, the infinite horizon contract is extended to two consumers case which internalizes the externality a consumer causes to another. In the two consumer case, consumers are strategically noninteracting; and it is shown that the producer acts as a budget balancer. These contracts are also shown to be economically efficient. The demand management contracts achieve both the procedural and end-state fairness. Also, the infinite horizon contracts are homeomorphic to infinite horizon alternating bargaining model. The efficiency of infinite horizon contracts is due to their homeomorphism with the alternating bargaining process as they exhaust all possible mutual gains from exchange. In the two-period model, the bargaining process is constrained and hence all possible mutual gains are not eliminated, leading to the inefficiency. In part II of the thesis, we discuss the notions of exchangeability in the Shapley value. The Shapley value is a probabilistic value for the transferable utility (TU) cooperative games, in which each player subjectively assigns probabilities to the events which define their positions in the game. In this part, the objective have been to explore the aspect of subjective probability which leads to the uniqueness of the Shapley value. This aspect of subjective probability is known as exchangeability. We derive the Shapley value using de Finetti’s theorem. We also show that, in the Shapley value, each player’s prospects of joining a t-player game as the last member of the game is a moment sequence of the uniquely determined uniform distribution. We stress on finite exchangeability; and deduce that, with finite exchangeability, the Shapley value is the only value in which the probability assignment is a unique mixture of independent and identical distributions. It is concluded that, in both the finite and infinite exchangeable cases, the uniqueness of probability assignment in the Shapley value is due to exchangeability and the mixing with the uniform distribution.

Magister Administrationis - MAdmin / This research investigates the performance of private sector participation (PSP) in the water sector from a governance perspective. It is concerned with the role that institutions play in the interaction between the state and the private sector, which occurs with respect to the regulation and implementation of such PSP arrangements. The research takes place within the context of a development debate and practice, which identifies water as a key poverty issue in a substantial part of the developing countries, which advocates private sector participation as a remedy to inadequate water management and which acknowledges good governance as a crucial requirement for development. Nevertheless, few studies have scrutinized the impact of governance and institutions on the outcome of PSP arrangements in the water sector. Most research on the performance of PSP arrangements has examined exogenous and endogenous determinants, such as the price mechanism and the property rights allocation, but these factors proved unsatisfactory as explaining variables in the context of natural resource management. To contribute to filling a gap in research this study aims at evaluating the impact of institutional frameworks on the outcome of private sector participation in water supply and sanitation through a case study of the Management Contract for Water and Wastewater Service in the Amman Governorate, Jordan. At the end of the 1990s the quality of water supply and sanitation in the Jordanian capital Amman was unsatisfactory, as supply was insufficient and entailed high costs. Therefore, in 1999, the government of the Hashemite Kingdom of Jordan contracted a private joint venture to improve water service provision in the Amman Governorate. The research takes into account the specific institutional framework for the mentioned arrangement in Amman, which is comprised of the national judicial and political institutions, the specific regulatory institutions as well as relevant international institutions. These institutions are not limited to laws and regulations only, but also include informal institutions such as traditions. The specific objective of this study is to show how the institutional framework of a transaction affects regulatory processes by abating and amplifying the potential for opportunistic behavior of the contracting parties, and thereby affecting the performance of a privately operated water utility. The examination of the institutional framework of the Amman Management Contract revealed that mainly judicial and international institutions and specific contract rules were constraining the discretion of the contracting parties. Political checks and balances were insufficiently established and the regulatory institutions of the water sector were set up in an improper way. The field study discovered that the resulting discretionary power of certain actor was used opportunistically, which had a detrimental effect on the outcome of the PSP arrangement. Nevertheless the overall performance of the arrangement was good from which the general insight was drawn that regulatory credibility may be developed even in unpropitious environments. However, to be able to judge upon the effect of governance and institutions on a planned or existing PSP arrangement each time a complex assessment of the respective institutional environment is necessary. This is because institutions may not be seen as independent building blocks but rather form a network which is likely to be unique for each country and situation. The mini-thesis is organized as follows. In Chapter 1 an outline of the study and its problem background is provided. Chapter 2 provides a detailed literature review and sets out the theoretical framework and research hypotheses of the study. Chapter 3 outlines the research design and methodology that was used for the study. Chapter 4 provides background detail on the Jordanian political, economic and social situation, on the issues pertaining to the water sector, andon the Amman water contract. Chapter 5 provides a description and analysis of the main research findings. Chapter 6 provides a summary as well as final conclusions and considerations.

Business management / M. Com. (Business management)

Business management / M. Com. (Business management)

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / O objeto desse estudo foi a análise dos processos de avaliação de desempenho e contratualização da gestão para profissionais de saúde na Atenção Primária à Saúde. Para tanto, após revisão de literatura nacional e internacional optou-se por um estudo de caso em Portugal, com a finalidade de conhecer a trajetória da reforma da atenção primária no país, sua estrutura organizacional e as ferramentas de gestão utilizadas para avaliação de desempenho nas Unidades de Saúde Familiar (USF). Esse estudo possibilitou o aprofundamento das discussões sobre os processos que vem sendo instituídos para atenção primária no Brasil, como o programa nacional de melhoria do acesso e qualidade na atenção básica (PMAQ- AB). Desta forma, os objetivos do estudo foram: analisar o contexto geral e as condicionalidades de implantação do sistema de avaliação profissional na APS, identificar os fatores facilitadores e limitantes da gestão, identificar as ferramentas de monitoramento e a percepção dos dirigentes sobre o processo. Trata-se de estudo com abordagem qualitativa, de natureza descritiva, com investigação narrativa, bibliográfica e documental. A pesquisa de campo em Portugal foi realizada através de entrevistas com aplicação de questionário semi-estruturado aos diretores executivos, coordenadores de USF, representantes do conselho clínico e unidade de apoio à gestão nos Agrupamentos de Centros de Saúde (ACES) selecionados. Como resultados, o trabalho aponta que uma nova estrutura de coordenação das unidades de saúde com a descentralização dos serviços, requerendo maior autonomia por parte dos gestores e profissionais de saúde, com enfoque no planejamento estratégico, aliados ao fortalecimento da capacidade de gestão dos dirigentes e regulamentação de um sistema de avaliação, tem contribuído para fortalecer o gerenciamento na APS. Aponta-se como fatores positivos do sistema de avaliação profissional, a redução na despesa pública com a utilização da gestão por objetivos, introdução da governança clínica, o trabalho em equipe, e uma maior responsabilização e motivação dos profissionais. Conclui-se que as experiências com sistemas de avaliação profissional e contratualização na APS apresentam um conjunto de recomendações que poderão beneficiar a evolução da reforma e melhoria do PMAQ no Brasil, considerando-se ainda sua fase inicial. / This thesis research aims at studying the process of performance evaluation and contracting management for health professionals within the context of primary care reform. It was performed a case study in Portugal to know the trajectory of primary care reform, studying its organizational model and management as well as the methodologies for performance evaluation and professional contracting. This study allowed the analysis of the processes that have been established for primary care in Brazil as the national program to improve access and quality in primary care (PMAQ-AB). The objectives of the study were to analyze the general context and constraints of the conditionalities system deployment job evaluation in APS, identify facilitating factors and limiting management process, identify the monitoring tools and the perception of managers on the process. This is an exploratory, descriptive narrative research, literature and documents, with a qualitative approach. Data collection consisted of a literature review, analysis of official documents and interviews with managers, coordinators of Family Health Units, council representatives and clinical unit management support in Clusters of Health Centers (ACES). As a result, the work points to a new coordination structure of health facilities with the decentralization of services, requiring greater autonomy on the part of managers and professionals, with a focus on strategic planning, combined with the strengthening of the management capacity of leaders and regulation of an evaluation system, has contributed to strengthening the management in Primary Health Care. Points as triggering factors of success when analyzing a system of professional evaluation, as the case of Portugal, the reduction in public spending, management by objectives, the introduction of clinical governance, teamwork, greater accountability of professionals and professional advancement, as a set of recommendations that would benefit the progress of reform and improvement PMAQ in Brazil, also considering its initial phase.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / O objeto desse estudo foi a análise dos processos de avaliação de desempenho e contratualização da gestão para profissionais de saúde na Atenção Primária à Saúde. Para tanto, após revisão de literatura nacional e internacional optou-se por um estudo de caso em Portugal, com a finalidade de conhecer a trajetória da reforma da atenção primária no país, sua estrutura organizacional e as ferramentas de gestão utilizadas para avaliação de desempenho nas Unidades de Saúde Familiar (USF). Esse estudo possibilitou o aprofundamento das discussões sobre os processos que vem sendo instituídos para atenção primária no Brasil, como o programa nacional de melhoria do acesso e qualidade na atenção básica (PMAQ- AB). Desta forma, os objetivos do estudo foram: analisar o contexto geral e as condicionalidades de implantação do sistema de avaliação profissional na APS, identificar os fatores facilitadores e limitantes da gestão, identificar as ferramentas de monitoramento e a percepção dos dirigentes sobre o processo. Trata-se de estudo com abordagem qualitativa, de natureza descritiva, com investigação narrativa, bibliográfica e documental. A pesquisa de campo em Portugal foi realizada através de entrevistas com aplicação de questionário semi-estruturado aos diretores executivos, coordenadores de USF, representantes do conselho clínico e unidade de apoio à gestão nos Agrupamentos de Centros de Saúde (ACES) selecionados. Como resultados, o trabalho aponta que uma nova estrutura de coordenação das unidades de saúde com a descentralização dos serviços, requerendo maior autonomia por parte dos gestores e profissionais de saúde, com enfoque no planejamento estratégico, aliados ao fortalecimento da capacidade de gestão dos dirigentes e regulamentação de um sistema de avaliação, tem contribuído para fortalecer o gerenciamento na APS. Aponta-se como fatores positivos do sistema de avaliação profissional, a redução na despesa pública com a utilização da gestão por objetivos, introdução da governança clínica, o trabalho em equipe, e uma maior responsabilização e motivação dos profissionais. Conclui-se que as experiências com sistemas de avaliação profissional e contratualização na APS apresentam um conjunto de recomendações que poderão beneficiar a evolução da reforma e melhoria do PMAQ no Brasil, considerando-se ainda sua fase inicial. / This thesis research aims at studying the process of performance evaluation and contracting management for health professionals within the context of primary care reform. It was performed a case study in Portugal to know the trajectory of primary care reform, studying its organizational model and management as well as the methodologies for performance evaluation and professional contracting. This study allowed the analysis of the processes that have been established for primary care in Brazil as the national program to improve access and quality in primary care (PMAQ-AB). The objectives of the study were to analyze the general context and constraints of the conditionalities system deployment job evaluation in APS, identify facilitating factors and limiting management process, identify the monitoring tools and the perception of managers on the process. This is an exploratory, descriptive narrative research, literature and documents, with a qualitative approach. Data collection consisted of a literature review, analysis of official documents and interviews with managers, coordinators of Family Health Units, council representatives and clinical unit management support in Clusters of Health Centers (ACES). As a result, the work points to a new coordination structure of health facilities with the decentralization of services, requiring greater autonomy on the part of managers and professionals, with a focus on strategic planning, combined with the strengthening of the management capacity of leaders and regulation of an evaluation system, has contributed to strengthening the management in Primary Health Care. Points as triggering factors of success when analyzing a system of professional evaluation, as the case of Portugal, the reduction in public spending, management by objectives, the introduction of clinical governance, teamwork, greater accountability of professionals and professional advancement, as a set of recommendations that would benefit the progress of reform and improvement PMAQ in Brazil, also considering its initial phase.

Submitted by Paulo Melo (sihibernon@uol.com.br) on 2013-02-15T15:08:58Z No. of bitstreams: 1 DISSERTAÇÃO_PAULO HIBERNON.pdf: 1106809 bytes, checksum: 7faa271fc900963dbe39d53617b1343c (MD5) / Approved for entry into archive by ÁUREA CORRÊA DA FONSECA CORRÊA DA FONSECA (aurea.fonseca@fgv.br) on 2013-05-06T14:33:38Z (GMT) No. of bitstreams: 1 DISSERTAÇÃO_PAULO HIBERNON.pdf: 1106809 bytes, checksum: 7faa271fc900963dbe39d53617b1343c (MD5) / Approved for entry into archive by Marcia Bacha (marcia.bacha@fgv.br) on 2013-05-07T20:03:43Z (GMT) No. of bitstreams: 1 DISSERTAÇÃO_PAULO HIBERNON.pdf: 1106809 bytes, checksum: 7faa271fc900963dbe39d53617b1343c (MD5) / Made available in DSpace on 2013-05-07T20:03:52Z (GMT). No. of bitstreams: 1 DISSERTAÇÃO_PAULO HIBERNON.pdf: 1106809 bytes, checksum: 7faa271fc900963dbe39d53617b1343c (MD5) Previous issue date: 2012-10-31 / The goal of this survey was to analyze the institutional model of the external control over the management contracts within the Financial Department of the state of Pernambuco in regards to its observance, by key players involved, of the contents of state laws which govern Social Organizations: the public administration sector, technicians within the Financial Department and members of its audit council. This study was based upon the following premises: that the new arrangements for the provision of public services through partnerships with Social Organizations, demand by the Financial Department, institutional models of objective inspection that strives for t ransparency when disclosing information; that the formatting process of such institutional models are dynamic, allowing that the contingencies experienced in its implementation might contribute to its improvement; and that these institutional drawings crea te impact upon the behaviour of the key players involved. The study was based upon documental analyses. The qualitative methodology of content analysis was chosen to analyze the data. The survey results showed that the institutional control of management c ontracts under the TCE - PE is characterized by its fragility as a mechanism for disclosure of information and therefore does not contribute to the reduction of information asymmetry that is established with the implementation of management contracts. Additi onally, this survey shows that the current institutional control model compromises and limits the performance of the Auditors Council to control these settings. Finally, it is shown that, despite its fragility, there was a low - compliance rate identified, a mong key players involved, in regards to implementing the current institutional model of control of management contracts; this implies a low institutionalization of this model. The results should provide a renewed discussion about the mechanisms of control of management contracts by TCE - PE, which may result in a new institutional model in order to bring out more transparency to partnerships with Social Organizations. / O objetivo desta pesquisa foi analisar o desenho institucional do controle externo sobre os contratos de gestão no âmbito do Tribunal de Contas do estado de Pernambuco quanto a sua aderência aos conteúdos da lei estadual que disciplina as Organizações Sociais e quanto a sua observância por parte dos atores envolvidos: Administração Pública, técnicos do tribunal de contas e membros do seu corpo julgador. Foram assumidas as seguintes premissas: que os novos arranjos de prestação de serviços públicos, por meio de parcerias com as Organizações Sociais, demandam por parte dos Tribunais de Contas desenhos institucionais de fiscalização específicos, que a pesar de variáveis devem primar por sua capacidade de revelar informações; que o processo de formatação destes desenhos institucionais deve ser dinâmico, permitindo-se que as contigências experimentadas na sua implementação possam contribuir no seu aperfeiçoamento; e que esses desenhos institucionais geram impacto no comportamento dos atores envolvidos. O estudo foi realizado por meio de pesquisa documental. A metodologia qualitativa de análise de conteúdo foi escolhida para análise dos dados. Os resultados da pesquisa permitiram concluir que o desenho institucional de controle dos contratos de gestão no âmbito do TCE-PE caracteriza-se por sua fragilidade como mecanismo de revelação de informação e, consequentemente, não contribui para a redução da assimetria de informação que se estabelece com a implementação dos contratos de gestão. Adicionalmente, compromete e limita o desempenho do Tribunal de Contas no controle destes ajustes. Verificou-se, também, uma a baixa observância do desenho institucional identificado, em que pese sua fragilidade, por parte dos atores envolvidos no controle dos contratos de gestão, implicando em uma baixa institucionalização deste desenho. Os resultados devem proporcionar uma rediscussão acerca dos mecanismos de controle dos contratos de gestão por parte do TCE-PE, que poderá resultar em um novo desenho institucional com vistas a conferir maior transparência às parcerias com as Organizações Sociais.

The article provides introductory notions about the new regulatory framework of the European Union on public procurement. The author argues that this new legislation forces us to rethink how articulate it to satisfies the public interest with respect to the principles of equality, efficiency, transparency, efficiency and accountability. It also forces us to rethink the administrative organization in the light of the own principles of public law. All that with the objective to approach us to the paradigm of the right to good administration as an element of control and accountability. / El artículo brinda nociones introductorias sobre el nuevo marco regulatorio de la Unión Europea sobre contratación pública. El autor sostiene que esta nueva normativa obliga a repensar en cómo articularla a fin de que satisfaga los intereses públicos con respeto a los principios de igualdad, eficacia, transparencia, eficiencia y rendición de cuentas. Además, obliga a repensar la organización administrativa a la luz de los propios fundamentos del derecho público. Todo ello con miras a acercarse al paradigma del derecho a una buena administración como elemento del control y de rendición de cuentas.