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Jul 15, Ciro Biderman, Renato Sergio De Lima, João Manoel Pinho De Mello, Alexandre De Lima: Forum Brasileiro de Segurança Pública. João De. Nov 7, 𝗣𝗗𝗙 | On Jun 1, , Roberto Alves Lourenço and others + Renato Bandeira de Mello at Universidade Federal do Rio Grande do Sul. Jul 25, Maintainer Renato Prado Siqueira user to connect with IBGE's (Instituto Brasileiro de Geografia e Estatistica).


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Copyright and all rights therein are retained by authors or by other copyright holders. In most cases, these works may not be reposted without the explicit permission of the copyright holder. Journal Publications A. Takahata, E. Nadalin, R. Ferrari, L. Duarte, R.

The pioneering companies based their organization on self-financing and physicians' quotas and expanded their clientele through fixed per capita transfers from Social Security.

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They were created by physician-proprietors based on physical outpatient care structures or hospitals the latter by the s Donnangelo MCF.

Many of these physicians were also salaried staff in various retirement and pension institutes and had to reorganize their professional affiliations due to the reduction in the number of employment relationships resulting from the unification of these institutes.

The clientele of the pioneering companies consisted exclusively of formal workers in companies from modern industries, and coverage often excluded their direct dependents. Although such company policies spread, they were not adopted by all employers. There were direct company-to-company "policies" without intermediation by the Social Security system, established through the retention of public funds earmarked for medical care, for the organization of the corporations' own medical care schemes Giffoni MR.

The 2nd National Development Plan II PND , designed to give new direction to the country's development, prioritized an increase in the country's energy capacity and the production of basic inputs and capital goods, seeking to replace the previous model, which had prevailed during the period of the economic "miracle" of , whose priority was durable consumer goods.

Brazilian Ministry of Health funds increased in relation to previous periods, and there were incentives for the creation of public institutional spaces for social policy planning and implementation of research projects Escorel S. Rio de Janeiro: Editora Fiocruz; However, subsidized loans from the Social Support Fund FAS financed the private hospital sector's installed capacity and leveraged health plan companies.

One example of corporate expansion stimulated by government investments was the creation of Amil based on an original set of hospitals, quintupling the number of beds from to Bahia B. Tensions between post-dictatorship re-democratization, the enactment of comprehensive social rights by the Constitution, and pressure for fiscal adjustment and curtailment of government spending in the context of a slowdown in economic growth hindered the implementation of the constitutionally mandated SUS, among other consequences.

The second oil price boom, the decision by the United States in to increase interest rates and close the financial market to indebted countries, and the growing hegemony of neoliberal thinking in the international arena Bielschowsky R, Mussi C.

The adjustment program under the Administration of President Collor, whose term began in , followed the three principles: privatization, deregulation, and liberalization of prices and wages. President Collor's inaugural address was explicit: "The state should be ready, permanently ready, to guarantee access by low-income people to certain vital goods.

It should provide access to housing, food, health, education, and public transportation for all those who depend on it Collor de Mello F. Discurso de posse no Congresso Nacional. Criticism of the inefficiency of public services Anderson P.

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Argentina: Consejo Latinoamericano de Ciencias Sociales; The Brazilian health system: history, advances, and challenges. Lancet ; During the so-called lost decades Bielschowsky R. Buenos Aires: Siglo Veintiuno Editores; The growth and diversification of activities of health plan companies attracted domestic investors and investments and some international insurance companies.

Still, the predominance of domestic capital was preserved.

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Rosemburg C. Exame ; The legislation stimulated the expansion of private health plans and insurance. With regard to demand incentives, the direct transfer of public funds to companies characteristic of the first cycle was replaced by indirect subsidies and payment of plans for government employees.

That is, the mobilization of fiscal policies combined with administrative provisions and the inclusion of spending on private plans in the government budgets.

On the supply side, the main rulings focused on the reduction of tax rates or tax exemptions on the Services Tax ISS Supremo Tribunal Federal.

The adoption of long-term loans from state-owned banks for charitable and private hospitals Braga IF. In the late s, various health plan companies began to congregate corporate groups, and the insurance companies not only entered the health care market, but also presented themselves in it as relevant interlocutors in the formulation of regulatory policies in the process of debates and approval of Law 9.

Scheffer M. The changes in the scale of operations of health plan companies enabled them to mediate the relations between the demand and health service providers in different conditions from those prevailing in the accumulation regime based on self-financing.

Brazilian corporate groups in the finance-dominated accumulation regime: the example of Amil The early 21st century witnessed renewed hopes for the recovery of growth and new linkage between social and economic policies for an inclusive development model.

There was evidence that that the basic macroeconomic conditions for sustained expansion had been reestablished. The increase in formal employment and improved income distribution signaled the recovery of Brazil's industrial capacity and prospects for generating endogenous technical progress Quadros WJ.

However, the systemic crisis that struck in the late s imposed fiscal requirements and pushed away the functions of energizing effective demand and productive profits, while economic policies became essential vectors for the macroeconomic reproduction of financial wealth Braga C. Estud Av ; Therefore, gains in access to and use of health care provided by the SUS were not limited to the growth of the private sector, a process that included competition for public human and financial resources Policies for the expansion of consumption energized not only the low-income credit segment, but also the marketing of health plans to income classes C and D, the so-called "new middle class" Meirelles R.

Villela F. And in , according to polls conducted by Meireles Meireles R. The history of Amil from until its sale to the American corporation UnitedHealth suggests that its adherence to capitalization via acquisitions was a strategy that both preceded and remained in force after it launched part of its capital on the Stock Exchange Table 3.

Scheffer M.

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The changes in the scale of operations of health plan companies enabled them to mediate the relations between the demand and health service providers in different conditions from those prevailing in the accumulation regime based on self-financing. Brazilian corporate groups in the finance-dominated accumulation regime: the example of Amil The early 21st century witnessed renewed hopes for the recovery of growth and new linkage between social and economic policies for an inclusive development model.

There was evidence that that the basic macroeconomic conditions for sustained expansion had been reestablished. The increase in formal employment and improved income distribution signaled the recovery of Brazil's industrial capacity and prospects for generating endogenous technical progress Quadros WJ.

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However, the systemic crisis that struck in the late s imposed fiscal requirements and pushed away the functions of energizing effective demand and productive profits, while economic policies became essential vectors for the macroeconomic reproduction of financial wealth Braga C.

Estud Av ; Therefore, gains in access to and use of health care provided by the SUS were not limited to the growth of the private sector, a process that included competition for public human and financial resources Policies for the expansion of consumption energized not only the low-income credit segment, but also the marketing of health plans to income classes C and D, the so-called "new middle class" Meirelles R.

Villela F. And in , according to polls conducted by Meireles Meireles R. The history of Amil from until its sale to the American corporation UnitedHealth suggests that its adherence to capitalization via acquisitions was a strategy that both preceded and remained in force after it launched part of its capital on the Stock Exchange Table 3.

Despite the shareholding changes, family control of Amil was maintained. The change in the company's accumulation regime, including launching part of its capital on the market and the acquisitions, increased the company's worth.

However, its capital expansion was considerably superior to the increase in the number of policies. Table 4 shows the values involved in the acquisition of Amil by UnitedHealth, evidencing the rapid appreciation of the Brazilian group's capital, as measured both by the increase in the nominal share value and especially in the multiplication of the company's capital both in Brazilian currency and U.

Table 4: download and sale values for Amil's shares and Amil Group's capital. Amil is now a company with foreign capital. Its former owner still heads the health business in Brazil.

Contrary to the history of other health plan corporate groups, including some acquired by Amil itself, changes in the company's formal shareholding structure did not include the removal of the former owners from action in its health business.

Its main leader and founder's influence even appears to have expanded, as witnessed by his presence in the meeting of the so-called "Brazilian GDP" group with the Minister of Finance Although assessments on the success or failure of financialization are beyond the scope of this paper, it appears plausible that the company's capital appreciation has opened select political channels to the corporate group.

Discussion The concentration and recent internationalization of health plan companies, as evidenced by the Amil story, allows different interpretations.

In the more conventional sense, the health plan and insurance industry is highly concentrated. In July , Amil operated 7. From a regional perspective, Ranking third, the industry can be seen as regressive or concentrated from the angle of the clients' income.

There is a positive association between family income and private health policy coverage.

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In , only 2. Internationalization of Brazilian health plan companies actually preceded authorization by Law 9, of Likewise, the investment by domestic and international funds in hospital and diagnostic laboratory networks preceded the legislation that allowed participation by foreign capital in health care activities, under Law 13, of Still, operations of the size involved in the acquisition of Amil required backing by the legislation and approval by the Federal Attorney General's Office, suggesting that the legal provisions and their interpretations were relevant for ensuring reliability in the eyes of foreign investors.

The mismatch between corporate internationalization practices and the legislation suggests complacency by public authorities in the face of strategies that anticipated changes in the capitalization rules. The finance-dominated accumulation regime of health plan companies in Brazil differs from that in the United States. While Amil launched shares on the Stock Exchange and remained under the strict control of its founding owners, the UnitedHealth Group has no defined controller, its capital is considered pulverized, and the corporate group's administration is professionalized UnitedHealth Group.

UnitedHealth group facts Q2, The Amil download involved acquisitions of UnitedHealth shares by Amil's ex-principal owner, paradoxically making him the largest individual shareholder and only foreigner to sit on the board of directors of the largest corporate group in the United States health plan and information industry Faria N. UnitedHealth fecha acordo para adquirir controle da Amil.

The preservation of ownership control suggests the non-implementation of strategies involving redistribution of profits and dividends among workers, including health care professionals and small individual investors. Although the expansion of health plan and health insurance companies has occurred even in economic cycles with lower growth, a slowdown in investments in the sector is possible.

The country's growing economy, rising middle-class, and policies stimulating the managed care sector make it a market with high potential for growth" However, part of this prediction failed to play out. The economic recession looming on the horizon since President Rousseff was sworn in for her second term in January limited the market's expansion.

Therefore, the public policies supporting privatization, including those stimulating financialization, were reedited and renewed, occupying a central role on the public agenda. The conceptual references from reflections on financialization and accumulation help shed light on the shareholding restructuring processes in the health plan industry. A relative separation was seen between the capital appreciation of a company that markets health plans and the number of its clients.

However, this observation does not allows inferences on other economic groups or companies in the industry, or even on each company in the Amil group itself, since there was no detailed description of each company's performance, including those involved in health care provision such as hospitals and diagnostic laboratories.

Final remarks Brazil has participated in the history of financialization of capitalism since its beginning, due to its important demands for credit and its position as an emerging power, made possible by high interest rates with high returns. Thus, Brazil's participation in the world economy imposed a financial rationality on a portion of the domestic business sector and fueled the domestic rent-seeking sectors.

Health plan companies consolidated in the late 20th century became a platform for financial investments in the early 21st century. The evidence of the importance of public policies for the expansion of different accumulation regimes in health plan companies self-financing, dependent on the scale of intermediation operations between supply and demand for medical and hospital care, and financialization is well-known even to foreign investors.

The mismatch between the growth of health plans and the overall economy can be explained by two factors. The first, more widespread, is the population's desire for guaranteed access to and use of health services.