Controle do Tribunal de Contas da União sobre as organizações sociais de saúde: entre o controle formal e o controle de resultados

Abstract

This dissertation examines the external control exercised by the Brazilian Federal Court of Accounts (Tribunal de Contas da União – TCU) over Social Organizations operating in the health sector, focusing on the tension between formalistic legality control and results-oriented control, which is characteristic of the Managerial Public Administration model. The study is situated within the context of the Brazilian State Reform of the 1990s, particularly the Master Plan for State Reform (Plano Diretor da Reforma do Aparelho do Estado – PDRAE) and Law No. 9,637/1998, which established the legal framework for Social Organizations and introduced management contracts based on goals and performance indicators. Starting from the premise that the Social Organizations model presupposes greater administrative flexibility in exchange for ex post control focused on efficiency, effectiveness, and performance, the research investigates whether the TCU’s oversight has incorporated this managerial rationale or whether it remains predominantly anchored in a formalistic approach. The study adopts a socio-legal and comprehensive legal approach, combining a specialized bibliographic review on the Third Sector, Managerial Public Administration, and external control with an empirical analysis of the TCU’s case law. The empirical dimension consists of a systematic examination of TCU rulings related to Health Social Organizations issued between 1998 and 2025. The decisions were selected, organized, and qualitatively categorized according to the nature of the control exercised, distinguishing between formal control, results-based control, and hybrid forms, as well as analyzing the influence of procedural instruments and the temporal evolution of the Court’s oversight practices. The findings indicate that, although there have been occasional advances in recognizing the relevance of performance assessment, goals, and policy outcomes, the TCU’s control over Health Social Organizations remains predominantly formalistic, with a strong emphasis on legal, procedural, and documentary compliance. The study concludes that this predominance of formal control limits the full alignment between the Social Organizations model and the premises of Managerial Public Administration, highlighting the need to improve external control mechanisms so as to strengthen results-based evaluation, policy effectiveness, and the generation of public value within the Brazilian Unified Health System (SUS).