Contratos coletivos de assistência médica suplementar: estudo de caso em empresa empregadora e sindicato no ramo metalúrgico em Minas Gerais

Abstract

Introduction: The Federal Constitution of 1988 establishes the Unified Health System (SUS) in 1988 and, even with its creation, health care for workers in Brazil is predominantly performed by the supplementary private health sector. The historical trajectory of medical care to workers carries traits inherited from the social security structure. The current shape of the Brazilian Health System is dichotomized in two sub-sectors: the public and the private. The latter, still stratified in a supplemental segment and a liberal / autonomous segment. Of special interest is the study of the supplementary sector constituted by 48.8 million beneficiaries in medical and / or dental care plans. Of these, approximately 80% have collective health care plans. Such plans have been the subject of negotiation in the demands for assistance between unions and companies, a process that contributes to the privatization of the health sector in Brazil. Objective: To understand the collective contracting of health plans for medical care to formal workers, using as central analysis the speeches of the social actors involved. Methodology: This is an exploratory case study with a qualitative contribution, carried out with a union representative and a representative of the employing company, from the metallurgical branch. The data were collected through documental analysis and semi-structured interview and analyzed from the perspective of discourse analysis proposed by Michel Foucault. Results: Over 19 years, the metallurgical category surveyed carried out 26 collective health care conventions and of these, 16 (61%) are clauses of medical-ambulatory health care or hospital and dental care plans. The employer made 42 collective health care agreements, 21 (50%) on the same subject. The perception of the interviewees about the health care of the workers being currently the responsibility of the collective health plans gave rise to three themes. The first one says about the role of the union and the company in the collective contracting of health care, the second emphasizes the position of the interviewees on the regulation of the supplementary sector exercised by the ANS and the third talks about the use of the services offered by the SUS by the workers. Final Thoughts: The correlated discourses result in reflections on the historical movement of collective contractions of health plan for the class of workers in Brazil. In the enunciated ones, we have seen to emerge innumerable problems of the past that still creep without solution, among them, the increasing privatization of the Brazilian health system.