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OBJECTIVE: Latin America has undergone major changes in psychiatric services over the past three decades. The authors aimed to assess the availability of service data and changes in psychiatric services in this region during the 1990-2020 period. METHODS: The authors formed a research network to collect data on psychiatric service indicators gathered between 1990 and 2020 from national registries in Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Panama, Paraguay, Peru, and Uruguay. Indicators included psychiatric beds in psychiatric and general hospitals overall, for children and adolescents, and for forensic populations; residential beds for substance use treatment; treatment slots in residential facilities and day hospitals; and outpatient facilities. RESULTS: Data availability varied among countries, service indicators, and time points. The median prevalence of psychiatric beds decreased in psychiatric hospitals from 5.1 to 3.0 per 100,000 people (-42%) and in general hospitals from 1.0 to 0.8 (-24%). The median prevalence estimates of specialized psychiatric beds for children and adolescents (0.18) and for forensic populations (0.04) remained unchanged. Increases in prevalence were observed for residential beds for substance use treatment (from 0.40 to 0.57, 43% increase), available treatment slots in residential facilities (0.67 to 0.79, 17%), treatment slots in day hospitals (0.41 to 0.54, 32%), and outpatient facilities (0.39 to 0.93, 138%). CONCLUSIONS: The findings indicate that treatment capacity shifted from inpatient to outpatient and community care. Most countries had a bed shortage for acute psychiatric care, especially for children and adolescents and forensic patients. More comprehensive and standardized mental health service registries are needed.

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This study aims to assess whether Ecuadorian health reforms carried out since 2008 have affected the efficiency performance of public hospitals in the country. We contribute to the literature by shedding new light on the effects on public healthcare efficiency for developing countries when policies move toward health equity and universal coverage. We follow a two-stage approach, wherein the first stage we make use of factor and cluster analysis to obtain three clusters of public hospitals based on their technological endowment; we exploit Data Envelopment Analysis for panel data in the second stage to estimate robust efficiency measures over time. Our innovative empirical strategy considers the heterogeneity of healthcare institutions in the analysis of their efficiency performance. The results show a significant decrease in the average efficiency of low and intermediate technology hospitals after the new constitution was adopted in 2008. The decline in efficiency coincides with the two reforms of 2010 and 2011 that brought on higher social security coverage.

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O objetivo desse ensaio foi analisar as implicações da BNCC do Ensino Médio para a Educação Física Escolar em reflexividade dialógica e dialética pela análise histórica e política. Por meio de constatações teórica-empíricas, mostramos uma ampla denúncia sobre os interesses neoliberais envolvidos na concepção educativa da reforma do Ensino Médio, já que essa política educacional sistematiza uma educação a serviço do capital, com um reflexo nefasto para a formação crítica e reflexiva das juventudes. Assim, a Educação Física perde cada vez mais espaço, seja pelo seu caráter optativo efetivado pelos "estudos e práticas" do componente curricular; pelo rebaixamento de sua carga horária; por sua falta de legitimidade na sociedade contemporânea; ou por seus princípios epistemológicos, políticos e pedagógicos que se distanciam de uma educação eficiente pautada na Pedagogia das competências. Por fim, defendemos a revogação da BNCC e a organização coletiva de um novo documento curricular.

The objective of this essay was to analyze the implications of High School NCCB for Physical Education in dialogical and dialectical reflexivity through historical and political analysis. Through theoretical-empirical findings, we show a broad denunciation of neoliberal interests involved in the educational conception of the High School reform, since this educational policy systematizes an education at the service of capital, with a disastrous reflection for critical and reflective formation of youths. Thus, Physical Education loses more and more space, either because of its optional character effected by "studies and practices" of the curricular component; lowered workload; lack of legitimacy in contemporary society; or epistemological, political and pedagogical principles that distance themselves from an efficient education based on Competence Pedagogy. Finally, we support the revokement of the NCCB, and the collective organization of a new curriculum.

El objetivo de este ensayo fue analizar las implicaciones de la BNCC de Enseñanza Media para la Educación Física Escolar en la reflexividad dialógica y dialéctica por medio del análisis histórico y político. Mediante hallazgos teórico-empíricos, mostramos una amplia denuncia de los intereses neoliberales involucrados en la concepción educativa de la reforma, ya que esta política educativa sistematiza una educación al servicio del capital. Así, la Educación Física pierde cada vez más espacio, ya sea por su carácter optativo efectuado por los "estudios y prácticas" del componente curricular; por la reducción de su carga de trabajo; por su falta de legitimidad en la sociedad contemporánea; o por sus principios epistemológicos, políticos y pedagógicos que se distancian de una educación eficiente basada en la Pedagogía de las competencias. Finalmente, defendemos la derogación de la BNCC y la organización colectiva de un nuevo documento curricular.

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Resumen El presente artículo indaga sobre los fundamentos y las características del discurso de desarrollo acuñado por el Banco Interamericano de Desarrollo a finales de la década de los sesenta del siglo pasado en América Latina. La perspectiva histórica que abordó, permitió comprender cómo desde la celebración del encuentro de gobernadores en Bogotá en 1969, el Banco adelantó una acción estratégica en la región basada en reformas institucionales y vinculadas con las agendas gubernamentales alineadas con las políticas de seguridad provenientes de Washington durante la guerra fría.

Abstract: This article investigates the foundations and features of the development discourse coined by the Inter-American Development Bank at the end of the 1960s in Latin America. The historical perspective that it addressed, allowed to understand how since the celebration of the Governorsı meeting in Bogota in 1969, the Bank advanced a strategic action in the region based on institutional reforms and linked to governmental agendas aligned with the security policies coming from Washington during the Cold War.

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Objective: This paper discusses issues related to the efficiency and sustainability of public spending on health in Brazil. Despite the achievements of recent decades, the Unified Health System (SUS) faces structural challenges with consequences on the access to public health services and on the financial protection of the population. Methods: The paper provides a brief overview of the public healthcare financing in Brazil over the last ten years and presents an efficiency analysis of the SUS public health spending, using data envelopment analysis (DEA) models for the years of 2013 and 2017. Results: In terms of public spending, the paradox that Brazil spends little but poorly on health still persists. Public expenditures on health are relatively lower than those observed in countries with health systems with similar characteristics, but public expenditures per capita grow at rates higher than the growth of gross domestic product (GDP) per capita. In terms of efficiency of public health spending, the analysis shows that there is potential to increase the efficiency of the SUS. In 2017, these inefficiencies amounted R$ 35.8 billion. In general, SUS primary healthcare (APS) is more efficient (63% and 68% in 2013 and 2017) than high and medium complexity care (MAC) (29% and 34% in the same years, respectively). Conclusion: Improving the efficiency of public spending on health is particularly important in the current context of low economic growth and strong fiscal constraints in the post-pandemic environment. Efficiency gains can be achieved with: (i) scale gains in the structure and operation of hospitals, (ii) integration of care in health care networks, (iii) increased density and better distribution of the health workforce, (iv) change in mechanisms and incentives to link payments to providers and professionals to health outcomes, with the PHC as the organizer of the system, (v) innovations in the management of health service providers, with an emphasis on public partnership models and private companies (PPPs) . The consolidation of the SUS depends on public policies to improve the efficiency and quality of services provided to the population.

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Objetivo: Este artigo discute questões relativas à eficiência e à sustentabilidade do gasto público com saúde no Brasil. A despeito das conquistas das últimas décadas, o Sistema Único de Saúde (SUS) enfrenta desafios estruturais com consequências no acesso aos serviços públicos de saúde e na proteção financeira da população. Métodos: O artigo traça um breve panorama do financiamento da saúde no Brasil nos últimos 10 anos e apresenta análise da eficiência do gasto público em saúde utilizando modelos de análise envoltória de dados (data envelopment analysis ­ DEA) para os gastos com o SUS nos de 2013 e 2017. Resultados: Do ponto de vista do financiamento do sistema público de saúde, persiste o paradoxo de que o Brasil gasta pouco, mas gasta mal. Os gastos públicos com saúde são relativamente menores que os observados em países com sistemas de saúde com caraterísticas semelhantes, porém os gastos públicos per ca pita crescem a taxas maiores do que o crescimento do Produto Interno Bruto (PIB) per capita. Do ponto de vista da eficiência, a análise demonstra que há potencial de aumentar a eficiência do SUS. Apenas em 2017 essas ineficiências somavam R$ 35,8 bilhões. De forma geral, a atenção primária à saúde (APS) do SUS tem eficiência maior (63% e 68% em 2013 e 2017) do que a atenção de alta e média complexidade (MAC) (29% e 34% nos mesmos anos, respectivamente). Conclusão: Melhorar a eficiência do gasto público com saúde é particularmente importante no contexto atual de baixo crescimento econômico e fortes restrições fiscais no ambiente pós-pandemia. Ganhos de eficiência podem ser alcançados com: (i) ganhos de escala na estrutura e operação dos hospitais, (ii) integração do cuidado em redes de atenção à saúde, (iii) aumento da densidade e melhor distribuição da força de trabalho em saúde, (iv) mudança nos mecanismos e incentivos para vincular os pagamentos aos provedores e profissionais aos resultados de saúde, tendo a APS como organizadora do sistema, (v) inovações na gestão dos provedores de serviços de saúde, com ênfase em modelos de parcerias público-privadas (PPPs). A consolidação do SUS depende de políticas públicas que melhorem a eficiência e a qualidade dos serviços prestados à população.

Objective: This paper discusses issues related to the efficiency and sustainability of public spending on health in Brazil. Despite the achievements of recent decades, the Unified Health System (SUS) faces structural challenges with consequences on the access to public health services and on the financial protection of the population. Methods: The paper provides a brief overview of the public healthcare financing in Brazil over the last ten years and presents an efficiency analysis of the SUS public health spending, using data envelopment analysis (DEA) models for the years of 2013 and 2017. Results: In terms of public spending, the paradox that Brazil spends little but poorly on health still persists. Public expenditures on health are relatively lower than those observed in countries with health systems with similar characteristics, but public expenditures per capita grow at rates higher than the growth of gross domestic product (GDP) per capita. In terms of efficiency of public health spending, the analysis shows that there is potential to increase the efficiency of the SUS. In 2017, these inefficiencies amounted R$ 35.8 billion. In general, SUS primary healthcare (APS) is more efficient (63% and 68% in 2013 and 2017) than high and medium complexity care (MAC) (29% and 34% in the same years, respectively). Conclusion: Improving the efficiency of public spending on health is particularly important in the current context of low economic growth and strong fiscal constraints in the post-pandemic environment. Efficiency gains can be achieved with: (i) scale gains in the structure and operation of hospitals, (ii) integration of care in health care networks, (iii) increased density and better distribution of the health workforce, (iv) change in mechanisms and incentives to link payments to providers and professionals to health outcomes, with the PHC as the organizer of the system, (v) innovations in the management of health service providers, with an emphasis on public partnership models and private companies (PPPs) . The consolidation of the SUS depends on public policies to improve the efficiency and quality of services provided to the population.

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BACKGROUND: The emergence of assisted reproductive technology (ART) in humans has been an important tool for the treatment of infertility. The number of treatments performed in Latin America has been increasing, and Mexico is the third country with the most assisted reproduction cycles performed in the region. However, Mexico lacks a national regulation for assisted reproduction. Therefore, it is necessary to implement regulations that allow for a safe clinical practice based on ethics which can be available to any social group. MAIN BODY: The aim of this review was to examine the existing legislation that regulates human assisted reproduction practices in Mexico, but also to examine the legal analysis of the policies, laws, and regulations in effect in some countries in Latin America, North America, and Europe. For this, seven databases were consulted, and 34 articles from 2004 to 2021 referring to the practice of ART within the legal framework and the anthropological analysis that this entails were analyzed. Eight documents were also consulted such as the Mexican General Health Law of the Official Journal of the Federation (February 7, 1984) with its last published reform (DOF 01-06-2021). And three official agency websites were also consulted. No specific legislation was found for human assisted reproduction practices in Mexico; however, assisted reproduction clinics are ruled under some agreements implemented by national organizations such as the Mexican Association of Reproductive Medicine and, at the Latin America level, the Latin America Network of Assisted Reproduction (abbreviated REDLARA in Spanish); in addition, the practice of ART is considered, although not explicitly, in the General Health Law. CONCLUSION: In Mexico, there is no legal regulation in charge of assisted reproduction practices, which is why there is an urgent need to establish human assisted reproduction laws without incurring discriminatory and unconstitutional acts, and at the same time, be in accordance with scientific advances. This will allow a considerable reduction in the violation of human rights.

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Resumen La transformación reciente de la Universidad latinoamericana ha sido definida por las necesidades y premisas del modelo neoliberal. En este artículo tratamos algunos de sus impactos sociales en Colombia por medio del análisis de las lógicas que tales transformaciones han implicado para las universidades privadas; en particular, la gestión académica, la contratación y evaluación docente, así como la producción de conocimiento. Puesto que se trata de un modelo universitario en función del mercado, las estrategias de control epistemológico en las instituciones privadas delimitan no solo las posibilidades de vincular la investigación a sectores sociales subalternos, sino también la promoción de conocimientos considerados improductivos. Como límites corporativos al conocimiento crítico del país, tales impactos no solo dan cuenta de los efectos del modelo neoliberal, sino que han sido una de las estrategias para su profundización.

Abstract The recent transformation of the Latin American university has been defined by the needs and premises of the neoliberal model. In this article, we discuss some of its social impacts in Colombia through the analysis of the logics that such transformations have implied for private universities; in particular, academic management, teacher recruitment, and teacher evaluation, as well as knowledge production. Since it is a market-driven university model, the strategies of epistemological control, in private institutions, limit not only the possibilities of linking research to subaltern social sectors, but also the promotion of knowledge considered unproductive. As corporate limits to critical knowledge in the country, such impacts not only account for the effects of the neoliberal model, but also have been one of the strategies for its deepening.

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Resumo: O presente artigo aborda o ensino remoto emergencial (ERE) no contexto das contrarreformas do Estado e da crise estrutural do capitalismo, a partir das imposições do modelo de educação terciária desenhada pelos organismos internacionais do capital. Explicita elementos da contrarreforma administrativa e do processo de reestruturação do mundo do trabalho, analisando-os de forma articulada à conjuntura e sinalizando alguns dos impactos para a formação profissional do Serviço Social.

Abstract: This article addresses emergency remote education (ERE) in the context of state counter-reforms and the structural crisis of capitalism, based on the impositions of the tertiary education model designed by international capital organizations. It explains elements of the administrative counter-reform and the process of restructuring the world of work by analyzing in an articulated manner and pointing out some of the impacts on the professional training of Social Work.

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Resumo O artigo busca compreender como mudanças exógenas são afetadas pelos contextos de implementação que encontram em cada local. A partir da análise da Lei 13.415/2017, que reforma o Ensino Médio no Brasil, verifica como as mudanças federais trazidas por esta política provocaram alterações nos estados e qual a variação que os contextos locais geraram na própria reforma. O artigo se baseia em uma pesquisa qualitativa que acompanhou os efeitos da publicação da Lei e o início do processo de implementação da reforma nos 26 estados e Distrito Federal ao longo de dois anos. O caso empírico foi analisado a partir das variáveis de conflito e ambiguidade que caracterizam os contextos de implementação. Estes achados contribuem para a literatura de implementação de políticas públicas, de reformas e mudanças na administração pública e de políticas de educação.

Resumen El artículo busca comprender cómo cambios exógenos son impactados por contextos de implementación establecidos en cada lugar. A partir del análisis de la Ley 13.415/2017, que reforma la Educación Media en Brasil, verifica cómo los cambios federales de esta política provocaron alteraciones en los estados y cómo los contextos locales generaron cambios también a la propia reforma. El artículo se basa en una investigación cualitativa que hizo seguimiento a los efectos de la publicación de la Ley y al inicio del proceso de implementación de la reforma en los 26 estados y el Distrito Federal a lo largo de dos años. El caso empírico fue analizado a partir de las variables de conflicto y ambigüedad que caracterizan los contextos de implementación. El artículo contribuye con la literatura de implementación de políticas públicas, de reformas a la administración pública y de políticas de educación.

Abstract The article seeks to understand how exogenous changes are impacted by implementation contexts established in each place. Based on the analysis of Law 13.415/2017, which reforms High School in Brazil, it verifies how the federal changes proposed by this policy caused alterations in the states and how the local contexts also generated changes in the reform itself. The article is based on a qualitative investigation that monitored the effects of the publication of the Law and the beginning of the process of implementing the reform in the 26 states and the Federal District over two years. The empirical case was analyzed based on the variables of conflict and ambiguity that characterize the contexts of implementation. The article contributes to the literature on the implementation of public policies, reforms in public administration, and education policies.

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O texto problematiza a atuação do Conselho Federal de Educação Física e seus Conselhos Regionais de Educação Física (CONFEF/CREF) na defesa dos trabalhadores(as) da Educação Física (EF). Parte de duas perguntas: O que é a Ação de Inconstitucionalidade (ADIn) nº 3.428/2005, sua origem, seu desenvolvimento e seu estágio atual; o que é o CONFEF/CREF e sua (in)capacidade de proteger os trabalhadores(as)? Objetiva subsidiar as posições do Movimento Nacional Contra a Regulamentação do Profissional de Educação Física (MNCR), fortalecer a luta sindical, contribuir com o Movimento Sindical em Defesa do Sistema de Proteção do Trabalho e dos(as) Trabalhadores(as). Como procedimentos de investigação valemo-nos da análise documental. Demonstra que esta ADIn procede, tem respaldo constitucional e que a atuação do CONFEF/CREF não lhe concede prerrogativas que permita proteger os trabalhadores(as). Conclui pela defesa organizada do Sistema de Proteção do Trabalho e do(a) Trabalhador(a) da Educação Física a partir das organizações, considerando que a luta pelos direitos é de interesse público, porque dizem respeito à vida dos(as) trabalhadores(as).

This article discusses the role of the Federal Council of Physical Education and its Regional Councils of Physical Education in the defense of Physical Education workers. It is moved by two questions: What is the Unconstitutionality Action nº 3.428/2005, its origin, its development, and its current stage; what is CONFEF/CREF and its (in)ability to protect the workers? It aims to support the stance of the National Movement Against the Regulation of Physical Education Professionals, to strengthen the labor union in its struggle, to contribute to the Union Movement in Defense of the Labor and Workers Protection System. As our investigation procedure, we used documentary analysis. It demonstrates that this ADIn is valid, has constitutional support, and that the activity of CONFEF/CREF does not grant it prerogatives that allow it to protect the workers. It concludes by the organized defense of the Labor Protection System and the Physical Education Worker based on the associations, considering that the fight for rights is of public interest, because it concerns the life of the workers.

El artículo hace problematización a la actuación del Consejo Federal de Educación Física y sus Consejos Regionales en la defensa de los trabajadores(as) de la Educación Física. Surge de dos preguntas: ¿Lo que es la Acción de Inconstitucionalidad nº 3.428/2005, su origen, su desarrollo y su etapa actual? ¿Lo que es el CONFEF/CREF y su (in)capacidad de proteger los trabajadores(as)? Se tiene como objetivos dar aportes a las posiciones del Movimiento Nacional Contra la Regulación de la Profesional de Educación Física, fortalecer la lucha sindical, contribuir con el Movimiento Sindical en Defensa del Sistema de Protección del Trabajo y de los Trabajadores(as). Como procedimiento de investigación fue utilizada un análisis documental. Demuestra que esta ADIn es legítima, tiene respaldo constitucional y que la actuación del CONFEF/CREF no concede prerrogativas hacia la protección del trabajador(a). Concluye con la defensa organizada del Sistema de Protección Laboral y del Trabajador de Educación Física con base en las asociaciones, considerando que la lucha por los derechos es de interés público, porque atañe a la vida de los trabajadores(as).

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The protests in Chile in October 2019 raised the issue of health reform to the public agenda again. This article reviews some of the explanations for why there was a widespread protest, including the expectations of continued progress, the emergence of a "fear-based populism" and the decline in legitimacy of most social and political actors. Using the theories of Kingdon to explain how reforms are placed on the political agenda, we describe how the protests raised health reform as a problem to be addressed, discuss the tendency toward consensus on policy options by technical health reform advocates, and examine the uncertain political processes that would be necessary for a consensus reform to be adopted and implemented. A lesson for reformers is the need to pay attention to growing signs of popular resentment over failures of health reforms to address accumulating problems and to try to address them with urgency to avoid populist crises.

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The city of Rio Grande, located on the right bank of the Patos Estuary, has been severely contaminated by mercury (Hg) due to anthropogenic activities that chiefly began in the eighteenth century. To investigate the natural mercury distribution along the salinity gradient in the estuary, three sediment cores were collected from a region of the estuary that has experienced less anthropogenic impacts, namely its left bank. Our study demonstrates that accumulation of Hg and formation of metal sulfide minerals take place in fine grain sediment horizons within the sampled sediment cores. Mercury immobilization in these sediments occurs via binding to organic matter coatings on fine grain sediment particles, as well as by incorporation into and/or co-precipitation with iron sulfide minerals. The grain size controls over Hg accumulation and sulfide mineral formation were statistically demonstrated using principal component analysis. Different fine particulate sediment deposition patterns occurred at each sampling location, which is attributed to the consequence of hydrological changes in the estuary resulting from navigation infrastructure reforms performed over the past 200 years in the local port (e.g., dredging) and its surroundings. We suggest that the port building and maintenance activities have influenced Hg distributions in the estuarine sediments.

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Resumo Em meados do século XVIII, a associação entre "gente" e "riqueza" reemergiu como uma tópica relevante para a literatura da razão de Estado, em que, por extensão, sedimentou-se um conjunto de controvérsias a respeito das melhores formas de aproveitar os enjeitados como população útil. Tanto na América quanto na Europa, a ênfase em torno da utilidade dos expostos indicava uma inflexão que secundarizou os significados religiosos do auxílio às crianças em favor dos interesses do Estado. Este artigo analisa os sentidos das reformas da assistência aos expostos em um período de aumento global dos índices de abandono e, em simultâneo, de endividamento de boa parte das instituições de acolhimento.

Abstract In the mid-eighteenth century, the association between "gentry" and "wealth" reemerged as a topic of relevance in the literature of the reason of State, in which, by extension, a number of controversies about the best ways to make use of abandoned children took root. In the Americas, as in Europe, the emphasis on the usefulness of unwanted children indicated a new slant in which the religious significance of caring for children was subordinated to state interests. A discussion is presented of the meanings of the reforms of care for unwanted children at a time of an overall increase in rates of abandonment and, simultaneously, of indebtedness of many of the institutions where they were taken in.

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Resumo Este artigo propõe um modelo para explicar falhas na adoção compulsória de novas práticas no ciclo de gestão financeira em municípios. Empiricamente, aplica-se o modelo à adoção de sistemas de controle interno (SCI) em municípios brasileiros. As evidências da análise qualitativa comparada (qualitative comparative analysis - QCA) em sete prefeituras mostram que, apesar de recursos humanos e de sistemas serem condição necessária, eles não são suficientes para a implementação das práticas de controle interno. O chamado capital institucional é uma condição sine qua non para a adoção de novas práticas de administração e controle financeiro em governos locais no Brasil. A adoção dessas reformas depende da atuação de uma rede de "atores com poder" que realizam trabalho institucional em prol das mudanças.

Resumen Este artículo propone un modelo para explicar fallas en la adopción obligatoria de nuevas prácticas en el ciclo de gestión financiera en municipios. Empíricamente, se aplica el modelo a la adopción de los sistemas de control interno en municipios brasileños. Las evidencias del análisis comparativo cualitativo (qualitative comparative analysis - QCA) en siete municipalidades demuestran que la existencia de recursos humanos y de sistemas son una condición necesaria, pero no suficiente para la implementación de las prácticas del control interno. El capital institucional es una condición sine qua non para la adopción de nuevas prácticas de gestión y control financiero en gobiernos locales en Brasil. La adopción de esas reformas depende del apoyo de varios "actores con poder" que realizan trabajo institucional en pro de las reformas.

Abstract This article proposes a theoretical framework to explain the failure of the compulsory adoption of new practices in the financial management cycle in local governments. The empirical analysis applies the framework to the control systems implementation in Brazilian municipalities. The findings of a qualitative comparative analysis applied to seven local governments show that despite human capabilities and information systems being a necessary condition, they are insufficient to deeply implement such internal control practices. Institutional capital is a condition sine qua non for the adoption of new practices on financial management and control in Brazilian local governments. The adoption of such reforms depends on an active network of powerful actors involved in institutional work supporting the changes.

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Conhecido por sua posição oposicionista ao governo FHC (PSDB), o PT e seus integrantes se colocaram contra a reforma da Previdência promovida pelo então governo do PSDB. No entanto, logo que se tornou governo, Lula (PT) não médio esforços para aprovar uma reforma nos mesmos moldes do governo antecessor. Neste sentido, o objetivo deste artigo é apresentar as propostas de reformas da Previdência dos governos FHC e Lula e identificar os argumentos dos deputados petistas proferidos durante as Seções do Grande Expediente da Câmara Federal no período que compreende a tramitação das reformas – entre 1995 e 1998 para a reforma do governo FHC, e em 2003 para a reforma do governo Lula –, com o intuito de verificar sua variação discursiva neste contexto entre as reformas, momento em que o partido inverte sua posição institucional. Para isso, serão utilizados os aspectos teóricos e metodológicos da teoria do discurso de Laclau Mouffe, tais como discurso, articulação e antagonismo, imprescindíveis para captura dos sentidos atribuídos as reformas pelos parlamentares do PT. Então, com a chegada do PT ao comando do Executivo Federal, as reformas marcam, de forma elucidativa, a variação do discurso dos integrantes do partido e, por isso, do próprio partido, tendo em vista ser uma das primeiras políticas implementadas pelo partido assim que se tornou governo.

Conocido por su posición oposicionista al gobierno FHC (PSDB), el PT y sus integrantes se colocaron contra la reforma de la Previdencia promovida por el entonces gobierno del PSDB. Sin embargo, tan pronto como se convirtió en gobierno, Lula (PT) no medio esfuerzos para aprobar una reforma en los mismos moldes del gobierno antecesor. En este sentido, el objetivo de este artículo es presentar las propuestas de reformas de la Previdencia de los gobiernos FHC y Lula e identificar los argumentos de los diputados petistas pronunciados durante las Secciones del Gran Expediente de la Cámara Federal en el período que comprende la tramitación de las reformas, entre 1995 y 1998 Para la reforma del gobierno FHC, y en 2003 para la reforma del gobierno de Lula, con el intuido de verificar su variación discursiva en este contexto entre las reformas, momento en que el partido invierte su posición institucional. Para ello, se utilizarán los aspectos teóricos y metodológicos de la teoría del discurso de Laclau y Mouffe, tales como discurso, articulación y antagonismo, imprescindibles para la captura de los sentidos atribuidos a las reformas por los parlamentarios del PT. En el caso de que el Gobierno de la República Bolivariana de las Naciones Unidas, en el marco de la Convención de las Naciones Unidas, Que se convirtió en gobierno.

Known for its opposition to the FHC (PSDB) government, the PT and its members opposed the Social Security reform promoted by the then PSDB government. However, as soon as it became government, Lula (PT) did not make average efforts to approve a reform in the same way as the predecessor government. In this sense, the objective of this article is to present the proposals of reforms of the Social Security of the governments FHC and Lula and to identify the arguments of the petistas deputies made during the Sections of the Great Expedient of the Federal House in the period that includes the process of the reforms - between 1995 and 1998 for the reform of the FHC government, and in 2003 for the reform of the Lula government - with the intuition of verifying its discursive variation in this context between the reforms, at which time the party reverses its institutional position. For that, the theoretical and methodological aspects of Laclau and Mouffe's discourse theory, such as discourse, articulation and antagonism, will be used to capture the meanings attributed to the reforms by the PT parliamentarians. Thus, with the arrival of the PT under the command of the Federal Executive, the reforms clearly mark the variation of the discourse of the members of the party and, therefore, of the party itself, in view of being one of the first policies implemented by the party. Which became government.

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Resumo Nos últimos anos, acirrou-se o debate internacional sobre diferentes concepções de universalidade em saúde, polarizado nas propostas de sistema universal versus cobertura universal em saúde. A concepção de cobertura universal tem sido difundida por organizações internacionais e incorporada às reformas dos sistemas de saúde de alguns países em desenvolvimento, inclusive na América Latina. O artigo explora os pressupostos e as estratégias relacionados à proposta de cobertura universal de saúde. Inicialmente contrastam-se as concepções de universalidade nos modelos de cobertura universal e de sistemas universais de saúde. A seguir, contextualiza-se o debate internacional, incluindo exemplos de diferentes sistemas de saúde. Por fim, discutem-se as implicações da concepção de cobertura universal para o direito à saúde no Brasil. A análise das diferentes concepções de universalidade e das experiências de países evidenciam que arranjos de seguros (privados ou sociais) não superam as fortalezas de sistemas públicos universais de saúde. A compreensão dos projetos em disputa no cenário internacional é fundamental para identificar possibilidades e ameaças à consolidação do Sistema Único de Saúde no Brasil.

Abstract In recent years the international debate about universality in health has been marked by a polarization between ideas based on a universal system, and notions proposing universal health coverage. The concept of universal coverage has been disseminated by international organizations and has been incorporated into health system reforms in several developing countries, including some in Latin America. This article explores the assumptions and strategies related to the proposal of universal health coverage. Firstly, a comparison is provided of the models of universal health coverage and universal health systems. This is followed by a contextualization of the international debate, including examples of different health systems. Finally, the implications of the proposal of universal coverage for the right to health in Brazil are discussed. The analysis of different concepts of universality and the experiences of different countries shows that health insurance-based models, either social or private, are not as satisfactory as public, universal health systems. Greater understanding about ongoing international projects is essential in order to identify the possibilities represented by the consolidation of the Unified Health System (SUS) in Brazil, as well as the risks of dismantling the SUS.

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OBJECTIVE: Health policies in Latin America are centered on the democratization of health. Since 2003, during the last generation of reforms, health systems in this region have promoted governance strategies for better agreements between governments, institutions, and civil society. In this context, we develop an evaluative research to identify trends and evidence of governance after health care reforms in six regions of Mexico. METHODS: Evaluative research was developed with a retrospective design based on qualitative analysis. Primary data were obtained from 189 semi-structured interviews with purposively selected health care professionals and key informants. Secondary data were extracted from a selection of 95 official documents on results of the reform project at the national level, national health policies, and lines of action for good governance. Data processing and analysis were performed using ATLAS.ti and PolicyMaker. RESULTS: A list of main strengths and weaknesses is presented as evidence of health system governance. Accountability at the federal level remains prescriptive; in the regions, a system of accountability and transparency in the allocation of resources and in terms of health democratization strategies is still absent. CONCLUSION: Social protection and decentralization schemes are strategies that have allowed for improvements with a proactive role of users and civil society. Regarding challenges, there are still low levels of governance and difficulties in the effective conduct of programs and reform strategies together with a lack of precision in the rules and roles of the different actors of the health system.

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O artigo tem por objetivo problematizar os discursos generalizantes e homogeneizantes do envelhecimento humano, que desconsideram as diferenças e desigualdades no modo de envelhecer, viver e representar essa etapa da vida. Aponta o utilitarismo desse discurso universalizante nas propostas de reformas das políticas sociais, especialmente da política de Previdência Social no Brasil. Analisa alguns pontos críticos da reforma da Previdência Social e aponta os determinantes estruturais do novo modelo de acumulação capitalista e da superestrutura neoliberal como raiz dos desiquilíbrios no sistema de proteção social. Trata-se de um artigo teórico, fundamentado numa revisão de literatura que buscou responder aos objetivos desta investigação.

The article aims to problematize the generalizing and homogenizing discourses of human aging, which disregard the differences and inequalities in the way of aging, living and representing this stage of life. It points out the utilitarianism of this universalizing discourse in the proposals for social policy reforms, especially the social security policy in Brazil. It analyzes some critical points of social security reform and points out the structural determinants of the new model of capitalist accumulation and of the neoliberal superstructure as the root of imbalances in the social protection system. This is a theoretical article, based on a literature review, the sought to respond to the research the goals.

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