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Abstract(s)
O estudo caracteriza o processo de formação de agenda de uma política pública de saúde em Portugal à luz dos modelos Multiple Streams e Advocacy Coalition Framework. O objeto de estudo é o Plano Nacional de Saúde, fundamento da política de saúde que define orientações estratégicas, esperando-se resultados de
saúde, apontando as recomendações internacionais no sentido da saúde em todas as políticas, dado o seu impacto e das determinantes da saúde na expetativa de vida com saúde das pessoas. Esta política possibilita comparabilidade entre países, quer estes adotem Beveridge e Serviço Nacional de Saúde (como Portugal)
quer não. A política pode ser explicada com a ajuda dos modelos MS e ACF combinados. Há atores-chave e instituições internacionais como a WHO com contributos decisivos, especialistas académicos e políticos atuando como empreendedores. Identificam-se stakeholders ativos e dinâmicos (ordens profissionais, sindicatos, indústria, opinião pública). O modelo ACF ajudou a interpretar os resultados que mostram que há coligações de defesa e interesses com um papel ativo, dificilmente se percebendo se os resultados decorrem de atuações legítimas ou ilegítimas. Há atores visíveis e invisíveis e há fatores de contexto com contributo. Com ajuda do modelo MS, interpretámos resultados que permitiram identificar 3 fluxos: problemas, da política e político, assim como a confluência destes fluxos para abertura de uma janela de oportunidade. O agendamento da política aconteceu num contexto de viragem política e ambiente tecnocrático. A sua motivação teve cariz económico, uma vez que os decisores políticos possuíam uma visão de instrumento de gestão e de cumprimento de objetivos e metas mais do que de política de orientação estratégica de saúde.Empreendedores agiram para que o PNS entrasse em agenda. As diferentes visões, experiência internacional e perceções da importância do PNS na preservação do SNS foram impulsionadores e geradores do seu agenda-setting e determinantes na formulação.
The study characterizes the agenda-setting process of a public health policy in Portugal in the light of Multiple Streams and Advocacy Coalition Framework models. The object of study is the National Health Plan, the foundation of health policy that defines strategic guidelines, expecting health results, in line with international recommendations for health in all policies (HIAP), given their impact and the determinants of health on people's expectations of a healthy life. This policy allows comparability between countries, whether they adopt Beveridge and a National Health Service (like Portugal) or not. The NHP process can be described using MS and ACF models combined. There are key players and international institutions such as WHO with decisive contributions, academic experts and politicians acting as policy entrepreneurs. It identifies the existence of active and dynamic stakeholders (professional organizations, trade unions, industry, public opinion). The ACF model helped to interpret the results, which show that there are defense coalitions and interests playing an active role, although it is difficult to see whether the results stem from legitimate or illegitimate actions. There are visible and invisible actors and contextual factors that contribute. With the help of the MS model, we interpreted the results and identified three flows: problems, politics and policy, as well as the confluence of these flows to open a window of opportunity. The policy agenda took place in a context of political change and a technocratic environment. The motivation was economic, the political decision-makers had a vision of the NHP policy as a management tool and fulfilment of objectives rather than a strategic health policy. Entrepreneurs acted to put the NHP on the agenda. The different visions, international experience and perceptions of the importance of the NHP in preserving the NHS were drivers and generators of its agenda-setting and determinants in its formulation.
The study characterizes the agenda-setting process of a public health policy in Portugal in the light of Multiple Streams and Advocacy Coalition Framework models. The object of study is the National Health Plan, the foundation of health policy that defines strategic guidelines, expecting health results, in line with international recommendations for health in all policies (HIAP), given their impact and the determinants of health on people's expectations of a healthy life. This policy allows comparability between countries, whether they adopt Beveridge and a National Health Service (like Portugal) or not. The NHP process can be described using MS and ACF models combined. There are key players and international institutions such as WHO with decisive contributions, academic experts and politicians acting as policy entrepreneurs. It identifies the existence of active and dynamic stakeholders (professional organizations, trade unions, industry, public opinion). The ACF model helped to interpret the results, which show that there are defense coalitions and interests playing an active role, although it is difficult to see whether the results stem from legitimate or illegitimate actions. There are visible and invisible actors and contextual factors that contribute. With the help of the MS model, we interpreted the results and identified three flows: problems, politics and policy, as well as the confluence of these flows to open a window of opportunity. The policy agenda took place in a context of political change and a technocratic environment. The motivation was economic, the political decision-makers had a vision of the NHP policy as a management tool and fulfilment of objectives rather than a strategic health policy. Entrepreneurs acted to put the NHP on the agenda. The different visions, international experience and perceptions of the importance of the NHP in preserving the NHS were drivers and generators of its agenda-setting and determinants in its formulation.
Description
Tese especialmente elaborada para obtenção do grau de Doutor em Administração Pública, especialidade em Administração da Saúde
Keywords
Políticas públicas; Multiple Streams; Advocacy Coalition Framework; agenda setting; janela de oportunidade; Plano Nacional de Saúde Portugal Public policy; Multiple Streams; Advocacy Coalition Framework; agenda setting; policy window; National Health Plan Portugal