Competing technological trajectories and health system paradigms in Brazil

The presentation focus on the transformation of the Health System in Brazil, using a Neo-Schumpeterian perspective, and the concepts of scientific (Khun) and technological (Dosi) paradigm, to set a research framework to study the main forces shaping its evolution and structuring. The hypothesis tests the existence of two distinct paradigms governing the Health System in Brazil in a conflicting tension to reach hegemonic dominance. The paradigms are labeled as Intensive in Social Technologies and the Intensive in Capital/Marketing Technologies. The objective is to analyze the main characteristics of each paradigm, to present a typology using social, economic, political and institutional categories and to propose cost effective health policies to decrease inequities. The methodology is based on the analysis of the scientific literature and uses secondary data to suggest a non linear trajectory of the two paradigms allowing for upward and downward inflexion dependent upon the action of economic, social and institutional forces. These forces are discussed taking the Capital Intensive Paradigm in an integrated and recursive model and the processes involved from the production to utilization of health technology. Selected indicators to observe the strengthening of the model, from the economic, institutional or cultural dominion are presented. The study points out to the emergence of new institutions, transformation of existing ones and the incentive structure as the main vectors of the system paradigms reinforcing the hegemony of one or other model. The application of this framework may allow for the testing specific research hypothesis on the interplay of factors linking to a paradigm configuration and to propose health policies guidelines to increase equity and performance of the health system in Brazil.