Governança e pressupostos comportamentais: possíveis relações nos contratos de gestão em saúde na Bahia

Abstract

Partnerships with private entities by agreeing on objectives and performance goals have become an alternative adopted by the government to ensure the provision of services within the Unified Health System (SUS). Other elements are incorporated to the dynamics of public service to deal with these new partners, among them, Public Governance. Thus, this dissertation poses a research question: How does the governance model of the Secretary of Health of the State of Bahia (Sesab) influence the behavior of Social Organizations (OS) in the provision of services in state hospital units in the light of the Transaction Cost Theory (TCT)? The objective is to propose suggestions for improving the governance model of the secretariat's management contracts based on the view of the players involved in the process. We opted for a descriptive, qualitative research, with the techniques of data collection being interviews and documentary research; for data analysis we used thematic categorical analysis. The results point to the incipient adherence of the characteristics identified in the relationship between the Sesab and the OS to those recommended for a collaborative management, in which publicization fits, and no elements were identified in the institutional structure that promote dialogue, negotiation, flexibility, new and flexible ways of relating, clarity of regulations, among others. Moreover, according to the perception of the interviewees and the documents analyzed, there are weaknesses in the administrative functions that support governance, such as planning and control. The identified situation contributes to spread the occurrence of limited rationality in the transaction, since the information to be processed by the agents of the relation are incomplete or asymmetric, favoring opportunistic behaviors, which are sources of transaction costs, given the need for monitoring implementation, contractual disagreements, need for renegotiation, litigation, among others. It is suggested, then, the institution of the Health Publicization Monitoring Commission, a space for dialogue, negotiation, and evaluation of the partnership, thus promoting the approximation and alignment of the interests and values of the partners (Sesab and OS), as well as the operationalization of the Monitoring and Evaluation Commission composed of a multidisciplinary team from the accounting, financial, and technical care areas, enabling a comprehensive view of the unit, which should be optimized from the implementation of the management information system of the publicized units. Considering that this dissertation was limited to the behavioral assumptions of TCT, it is interesting to promote new studies that contemplate the attributes of TCT in management contracts in Sesab, such as uncertainty and asset specificity and how they influence or are influenced by governance. Regarding governance, the study was limited to the administrative institutional dimension, and it is important that other dimensions are contemplated in future studies, expanding the set of information about this theme, especially for its multifaceted character.