Políticas de saúde no Brasil nos anos 2000: a agenda federal de prioridades Health policies in Brazil in the 2000s: the national priority agenda

O artigo analisa as prioridades da política nacional da saúde no período de 2003 a 2008, correspondente ao Governo Lula. A pesquisa envolveu revisão bibliográfica, análise documental, análise de dados e entrevistas com dirigentes federais. Foram identificadas quatro prioridades na agenda federal da saúde: a Estratégia Saúde da Família, o Brasil Sorridente, os Serviços de Atendimento Móvel de Urgência e o programa Farmácia Popular. A primeira configura uma política de alta densidade institucional, iniciada no governo anterior, constituindo um exemplo de "dependência da trajetória". As demais foram adotadas como marcos de governo e trouxeram inovações em áreas em que havia fragilidades da atuação federal. As quatro políticas prioritárias analisadas se voltam para problemas relevantes do sistema de saúde brasileiro, porém apresentam diferenças quanto à sua trajetória, base de apoio e implicações para os princípios do Sistema Único de Saúde. Apesar de mudanças incrementais, observou-se a predominância de elementos de continuidade na política nacional de saúde no período.<br>This article analyzes Brazilian national health priorities from 2003 to 2008 under the Lula Administration. The study included a literature review, document analysis, and interviews with Federal health administrators. Four priorities were identified on the national health agenda: the Family Health Program, Smiling Brazil, Mobile Emergency Services, and the Popular Pharmacy Program. The first is a policy with high institutional density launched by the previous Administration, constituting an example of path dependence. The other three are innovations in areas where there had been weaknesses in Federal government action. The four policy priorities are strategies focused on solving key problems in the Brazilian health system. However, they display important differences in their historical development, political and institutional base, inclusion on the Federal agenda, and implications for the principles of the Unified National Health System. Although incremental changes have been introduced, national health policy has been characterized predominantly by continuity

Willingness to Pay for a Quality-Adjusted Life-Year: The Individual Perspective

AbstractObjectiveThe aim of this study was to elicit the individual willingness to pay (WTP) for a quality-adjusted life-year (QALY).MethodsIn a Web-based questionnaire containing contingent valuation exercises, respondents valued health changes in five scenarios. In each scenario, the respondents first valued two health states on a visual analog scale (VAS) and expressed their WTP for avoiding a decline in health from the better health state to the worse, using a payment scale followed by a bounded open contingent valuation question.AnalysisWTP per QALY was calculated for QALY gains calculated using VAS valuations, as well as the Dutch EQ-5D tariffs, the two steps in the WTP estimations and each scenario. Heterogeneity in WTP per QALY ratios was examined from the perspective of: 1) household income; and 2) the level of certainty in WTP indicated by respondents. Theoretical validity was analyzed using clustered multivariate regressions.ResultsA total of 1091 respondents, representative of the Dutch population, participated in the survey. Mean WTP per QALY was €12,900 based on VAS valuations, and €24,500 based on the Dutch EuroQoL tariffs. WTP per QALY was strongly associated with income, varying from €5000 in the lowest to €75,400 in the highest income group. Respondents indicating higher certainty exhibited marginally higher WTP. Regression analyses confirmed expected relations between WTP per QALY, income, and other personal characteristics.ConclusionIndividual WTP per QALY values elicited in this study are similar to those found in comparable studies. The use of individual valuations in social decision-making deserves attention, however