A contribuição da sociedade cooperativa no acesso da população aos serviços de saúde: o caso da Unimed – cooperativa de trabalho médico

Abstract

Health is a socially relevant, current and challenging topic because it directly implies the reproduction of life and the guarantee of well-being. The Federal Constitution of 1988 defined that access to health is a right of citizenship, and the Public Power is responsible for regulating, supervising and controlling services, and may be carried out by public or private institutions (merchant companies or cooperatives), the latter in a complementary way to the Unified Health System (SUS). The general objective of this thesis is to analyze the contribution of Unimeds as a cooperative organization in the provision of supplementary health services (provision of services in the private sphere) and in public policies, considering the principles advocated by the SUS in Brazil. The specific objectives propose to deepen the theme of cooperativism and its specificities in the provision of health services to the population, evaluating and identifying the tensions faced by the public policy of supplementary health. This is a qualitative research, whose methodology is composed of documentary research, semi-structured interviews with managers, cooperative members and customers in two Unimed units in the state of Tocantins, as well as content analysis of the material produced. The Unimed System is the largest cooperative system of medical work in the world and the largest network of medical assistance in Brazil, present in 86% of the national territory, which is a consistent differential in relation to other health plan operators, as it is present in locations in the countryside of the country where the others have no interest in being, for marketing reasons. Through powerful legislation, the State gradually transfers to supplementary health several of its constitutionally established responsibilities. The regulation process is inserted in a scenario of disputes of conflicting interests that specify its format and scope. The study found that the interiorization of the Unimeds attests to the facilitated and qualified access to health services, by offering the community the possibility of care by specialist doctors, clinics and laboratories, highlighting a qualitative and differentiated form of care provided by the SUS, which performs most of their care by family doctors and general practitioners. The maintenance of the governing principles of cooperativism is an imperative challenge for the very survival of Unimeds, especially in the face of the necessary community responsibility, and the distinctive training of the cooperative doctor, with a view to a differentiated and humanized practice of medicine, which is still far from being achieved. The Unimed System has still not been able to make the State aware that the recognition of its cooperative legal nature would enable the establishment of innovative partnerships, with the purpose of providing qualitative services in a complementary way, that is, carried out in the area of public health in partnership with the SUS. Given this situation, Unimed is an entity exogenous to the SUS.