The Health Fund and its appropriation by Social Organizations in the municipality of São Paulo

ABSTRACT The Health Fund of the municipality of São Paulo has been discussed, highlighting the appropriation of its resources by the private sector, especially by Social Organizations (OS). To this end, the first part presents the more general foundations of the Public Fund. The second part analyzes the historical trajectory of the Municipal Health Fund and the use of its resources, to a large extent, to finance primary care, via the Family Health Program executed by the OS. The third part presents the characteristics of the OS, analyzing the evolution of the appropriation of resources of the Health Fund between 2011 and 2021. It can be seen that the Health Fund resources are increasingly appropriated by these private entities, with a growing trend, reaching a level of 89.2% of total resources in 2021. Thus, the movement of implicit mercantilization is verified, marked by the logic of expansion of market mechanisms in the municipal Unified Health System.

摘要 圣保罗市卫生基金议题引发广泛讨论，其核心争议点在于私营部门，尤其是社会组织（Social Organizations，OS）对该基金资源的占用行为。为此，本文第一部分阐述公共基金的一般性理论基础；第二部分分析市政卫生基金的历史发展轨迹与资源使用格局，其资源绝大部分通过社会组织执行的家庭健康计划（Family Health Program）用于资助初级卫生保健服务；第三部分介绍社会组织的基本特征，并剖析2011至2021年间卫生基金资源的占用演化趋势。研究结果显示，此类私营实体对卫生基金资源的占用比例呈持续上升态势，2021年占总资源的比例已达89.2%。由此可见，市级统一卫生系统（Unified Health System）中市场机制扩张的逻辑愈发凸显，隐性商品化的发展趋势已然得到证实。