From the specific actions to government mark: medicine in the trajectory of the national policy of education and work regulation in health

Abstract This article analyzes the trajectory of the Brazilian policy of education and work regulation considering institutional issues and forms of incorporation of medicine on the policy, comprising the period from 2003 to 2015. This study was based on contributions of historical institutionalism, involving the analysis of legal and normative documents, interviews with state personnel and data from federal financing reports of the policy. Five key moments were defined, considering political-institutional contexts, governmental initiatives, and the insertion of medicine into the agenda of governments. The emphasis on the medical profession evolved from one-off actions to the status of a landmark, in a context of loss of space of the health workforce agenda and increasing prioritization of education actions, associated with institutional gains and changes in funding. The More Doctors Program resulted from the dynamics of the trajectory, incorporating advances in the training and incorporation of physicians into the Unified Health System of Brazil. Challenges remain, however, related to precarious employment relationships, the privatization of medical education, and professional regulation that considers the exercise of medicine in the private sector.摘要 本文针对2003年至2015年巴西教育与劳动监管政策的发展轨迹展开分析，重点考量制度性议题以及医学领域纳入该政策的具体路径。本研究以历史制度主义的理论成果为支撑，研究方法涵盖法律与规范性文件分析、国家公职人员访谈以及政策联邦融资报告数据提取。研究结合政治制度语境、政府施政举措以及医学议题纳入政府议事日程的进程，界定了五个关键时间节点。在卫生人力议题议程空间被压缩、教育行动愈发受到政策优先重视的背景下，伴随制度性收益与融资模式的变革，针对医疗行业的关注从一次性临时性举措逐步升级为标志性政策事件。更多医生计划（More Doctors Program）正是该政策轨迹动态演进的产物，其将医师培训与执业准入的相关进展融入巴西统一卫生系统（Unified Health System）建设中。然而当前仍存在若干挑战：包括不稳定的雇佣关系、医学教育私有化，以及针对私人执业场景的医疗行业监管规范不完善等问题。