The entry of foreign capital into the health system in Brazil

The study describes the history of legislation, analyzes the trajectory and the amount of foreign capital in the Brazilian health system. The Organic Health Law restricted the participation of foreign capital; sectoral legislation, however, allowed its subsequent entry into supplementary medical care and, in 2015, a new law promoted unrestricted openness, including in hospitals and healthcare services. Our study analyzes documents, legislation, and data obtained from secondary public bases or via the Law on Access to Information. Direct investments and merger and acquisition acts in the private health sector were considered. Five phases were identified: inaugural planning, regulated expansion, legal restriction, sectorized release, and expanded opening. From 2016 to 2020, the amount of foreign resources entering the country’s healthcare services was almost ten times more than the previous five-year period. Thirteen companies or funds were identified, most of them from the United States. Regulation allowing for the opening of foreign capital were preceded by business lobbies and public-private interactions that can affect the quality of public policies and the integrity of the legislative process. The invested capital seeks established and profitable companies in various segments of activity. Admission occurs in non-universal private care networks, which serve specific, geographically concentrated clientele. We conclude that foreign capital, an element of health financialization process, is expressed as a possible vector of the expansion of inequalities in the population’s access to health services and as an additional obstacle to the consolidation of the Brazilian Unified National Health System.

本研究梳理了立法沿革，分析了巴西医疗体系中外资的发展轨迹与规模。《有机卫生法》（Organic Health Law）对外资参与设置了准入限制；但行业性立法随后允许外资进入补充医疗领域，并于2015年通过新法推行全面开放，覆盖医院及医疗服务范畴。本研究通过公开二级数据库或依据《信息获取法》（Law on Access to Information）获取的文件、立法文本与数据开展分析，纳入私人医疗领域的直接投资与并购行为。研究识别出五个发展阶段：初始规划期、规范化扩张期、法律限制期、分领域放开期与全面开放期。2016至2020年间，流入该国医疗服务领域的外资规模几乎为前一个五年周期的十倍。本次研究共识别出13家企业或基金，其中多数来自美国。在允许外资放开的监管政策出台前，存在商业游说与公私互动行为，此类活动可能损害公共政策质量并影响立法程序的公正性。投入的资本瞄准各业务板块中运营成熟、盈利能力可观的企业，投资布局于非全民覆盖的私人医疗网络，该网络服务于特定地理区域内的集中客户群体。本研究得出结论：作为医疗金融化进程的构成要素，外资既是加剧人群健康服务可及性不平等的潜在推手，也成为巴西全国统一国家卫生系统（Brazilian Unified National Health System）整合完善的额外阻碍。