{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T21:09:29Z","timestamp":1766178569811,"version":"3.37.3"},"reference-count":62,"publisher":"FapUNIFESP (SciELO)","issue":"6","license":[{"start":{"date-parts":[[2021,6,1]],"date-time":"2021-06-01T00:00:00Z","timestamp":1622505600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,6,1]],"date-time":"2021-06-01T00:00:00Z","timestamp":1622505600000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,6,1]],"date-time":"2021-06-01T00:00:00Z","timestamp":1622505600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Ci\u00eanc. sa\u00fade coletiva"],"abstract":"<jats:p>Resumo \u00c0 luz da an\u00e1lise comparada de sistemas de sa\u00fade (SS), discutimos tr\u00eas fen\u00f4menos estrat\u00e9gicos para a universaliza\u00e7\u00e3o do SUS: a) os gastos tribut\u00e1rios em sa\u00fade; b) o financiamento estatal de planos privados de servidores p\u00fablicos; c) a demanda sindical por planos privados. Dentre os tipos-ideais de SS, o SUS \u00e9 universal na lei, mas h\u00edbrido na pr\u00e1tica: beveridgeano na aten\u00e7\u00e3o prim\u00e1ria \u00e0 sa\u00fade (APS) e misto no cuidado especializado\/hospitalar; sem ser universal na realidade (gastos p\u00fablicos s\u00e3o s\u00f3 43% dos gastos totais em sa\u00fade). H\u00e1 grande subs\u00eddio estatal ao setor privado, via gastos tribut\u00e1rios em sa\u00fade (30% do or\u00e7amento federal na sa\u00fade) e financiamento de planos privados para servidores p\u00fablicos, o que gera incoer\u00eancia, segmenta\u00e7\u00e3o do sistema de sa\u00fade e iniquidades. Apesar do apoio gen\u00e9rico ao SUS, os movimentos sindicais vem usando planos de sa\u00fade na contrata\u00e7\u00e3o coletiva (76% deles), refor\u00e7ando o setor privado. A redu\u00e7\u00e3o dos gastos tribut\u00e1rios em sa\u00fade - incluindo o financiamento estatal dos planos privados de servidores - aumentaria significativamente o or\u00e7amento do SUS e facilitaria a articula\u00e7\u00e3o entre sanitaristas e sindicalistas, aproximando a grande for\u00e7a dos sindicatos da longa luta pela universalidade do SUS e da APS.<\/jats:p>","DOI":"10.1590\/1413-81232021266.22602019","type":"journal-article","created":{"date-parts":[[2021,7,3]],"date-time":"2021-07-03T08:06:41Z","timestamp":1625299601000},"page":"2323-2333","source":"Crossref","is-referenced-by-count":4,"title":["Obst\u00e1culos \u00e0 universaliza\u00e7\u00e3o do SUS: gastos tribut\u00e1rios, demandas sindicais e subs\u00eddio estatal de planos privados"],"prefix":"10.1590","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0650-8289","authenticated-orcid":false,"given":"Charles Dalcanale","family":"Tesser","sequence":"first","affiliation":[{"name":"Universidade Federal de Santa Catarin,  Brasil"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5761-2660","authenticated-orcid":false,"given":"Mauro","family":"Serapioni","sequence":"additional","affiliation":[{"name":"Universidade de Coimbra,  Portugal"}]}],"member":"530","published-online":{"date-parts":[[2021,6]]},"reference":[{"issue":"6","key":"ref1","doi-asserted-by":"crossref","first-page":"2035","DOI":"10.1590\/1413-81232018236.05992018","article-title":"Sustentabilidade do SUS e ren\u00fancia de arrecada\u00e7\u00e3o fiscal em sa\u00fade","volume":"23","author":"Ock\u00e9-Reis CO","year":"2018","journal-title":"Cien Saude Colet"},{"issue":"5","key":"ref2","first-page":"1398","article-title":"Rela\u00e7\u00e3o p\u00fablico-privado no sistema de sa\u00fade brasieiro: opacidade cognitiva e anal\u00edtica","volume":"13","author":"Menicucci TMG","year":"2008","journal-title":"Cien Saude Colet"},{"key":"ref3","series-title":"Teoria da reforma sanit\u00e1ria: di\u00e1logos cr\u00edticos","first-page":"291","volume-title":"Entre o consenso e o minotauro da sa\u00fade: um balan\u00e7o da estrat\u00e9gia da Reforma Sanit\u00e1ria Brasileira","author":"Silva THS","year":"2018"},{"year":"2016","series-title":"Sistema de sa\u00fade no Brasil: organiza\u00e7\u00e3o e financiamento","author":"Marques RM","key":"ref4"},{"year":"2013","series-title":"Financiamento p\u00fablico da sa\u00fade: uma hist\u00f3ria \u00e0 procura de rumo","author":"Piola SF","key":"ref5"},{"key":"ref6","series-title":"Teoria da Reforma Sanit\u00e1ria: di\u00e1logos cr\u00edticos","first-page":"247","volume-title":"As mudan\u00e7as de dire\u00e7\u00e3o nas pol\u00edticas de sa\u00fade: atores e estrat\u00e9gias ocultas na implementa\u00e7\u00e3o do Sistema \u00danico de Sa\u00fade","author":"Monteiro MG","year":"2018"},{"issue":"1","key":"ref7","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1080\/13876980500513558","article-title":"Comparing Health Policy: An Assessmentof Typologies of Health Systems","volume":"8","author":"Burau V","year":"2006","journal-title":"J Comp Policy Analysis: Res Pract"},{"year":"1990","series-title":"Sobre a teoria das Ci\u00eancias Sociais","author":"Weber M","key":"ref8"},{"year":"1991","series-title":"National Health Systems of the World","author":"Roemer M","key":"ref9"},{"issue":"3","key":"ref10","doi-asserted-by":"crossref","first-page":"339","DOI":"10.2307\/3350371","article-title":"Health systems reforms in industrialized democracies: an emerging paradigm","volume":"73","author":"Chernichovsky D","year":"1995","journal-title":"Mil-bank Q"},{"issue":"5","key":"ref11","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1016\/0277-9536(96)00151-7","article-title":"Health system reforms. 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