Expansion and privatization of medical courses and teaching-service integration: the case of the state of Pernambuco

ABSTRACT The research explored the challenges arising from the expansion of public and private medical courses in the state of Pernambuco, based on the premise of teaching-service integration within the specialized health network. The study is a descriptive-exploratory case study that uses techniques which combine quantitative and qualitative research approaches. The privatization process in the state took place at a slower pace than nationwide in the Country. In the year 2000, there were only 290 vacancies in two public institutions. In only two decades, a total of 1.350 have been reached, with 1.130 of them located in the private sector. The research highlighted policies and actions related to the programmatic centrality of teaching-service integration, from which the concern with the immoderate nature of the expansion of courses with immediate repercussion on the allocation of students to training vacancies and the lack of integrated planning between the educational apparatus, health services, and SUS (Unified Health System) management stood out. Thus, the intention of the public sector to bring order into the growing presence of the private sector in medical education has not been matched by political decision-making regarding teaching-service integration, turning the nonimplementation of the Public Health Action Organizational Contract (COAPES) into a paradigmatic case.

摘要 本研究基于巴西伯南布哥州专科医疗网络中的教学-服务一体化前提，探讨该州公立与私立医学课程扩张所引发的诸多挑战。本研究为描述性探索性个案研究，采用定量与定性研究相结合的方法。该州的医疗私有化进程相较于巴西全国平均节奏更为缓慢。2000年时，仅两家公立机构设有290个医学培训名额。短短二十年间，总培训名额已达1350个，其中1130个位于私立院校。研究重点剖析了与教学-服务一体化纲领性核心相关的政策与举措，其中凸显出两大核心问题：一是课程扩张速度失控，直接影响学生培训名额的分配；二是教育体系、医疗服务机构与统一健康系统（SUS, Unified Health System）管理方之间缺乏统筹规划。因此，尽管公共部门意图规范私立机构在医学教育领域不断扩张的态势，但教学-服务一体化相关的政治决策却未能匹配这一目标，导致《公共卫生行动组织合同（COAPES，Public Health Action Organizational Contract）》未能落地，成为极具典型性的案例。