Análise dos fundamentos do modelo value-based health care delivery à luz das teorias de estratégia

O setor de saúde, globalmente, apresenta problemas relacionados aos seus custos, qualidade e acesso. Porter e Teisberg (2004, 2006) propuseram modelo de gestão específico para a administração estratégica na área, o Value-Based Health Care Delivery (VBHCD). O modelo teve relativa repercussão e vem influenciando muitos atores no setor. Contudo, o modelo vem sendo aceito sem o devido questionamento de seus fundamentos e consistência com a teoria em estratégia. O presente trabalho busca, por meio de um ensaio teórico, analisar o modelo proposto à luz de paradigmas gerais da estratégia empresarial como, por exemplo, o modelo de Porter e a Visão Baseada em Recursos (RBV). Inicialmente, o artigo sintetiza as explicações teóricas do modelo porteriano clássico e da RBV. Em seguida, o VBHCD é examinado comparado a essas explicações, buscando-se relações e, eventualmente, contradições. Conclui-se que o modelo VBHCD não se alinha integralmente a nenhum corpo teórico isoladamente. Mesmo sendo proposto por Porter, parte de seus fundamentos advém, na verdade, de outras correntes teóricas. Esta abordagem integradora de teorias concorrentes, apesar de presente na literatura, ainda apresenta dificuldades e barreiras, um aspecto que não está explícito no modelo

The revenge of the market on the rentiers why neo-liberal reports of the end of history turned out to be premature

Starting from the perspective of heterodox Keynesian-Minskyian-Kindlebergian financial economics, this paper begins by highlighting a number of mechanisms that contributed to the current financial crisis. These include excess liquidity, income polarisation, conflicts between financial and productive capital, lack of intelligent regulation, asymmetric information, principal-agent dilemmas and bounded rationalities. However, the paper then proceeds to argue that perhaps more than ever the ‘macroeconomics’ that led to this crisis only makes analytical sense if examined within the framework of the political settlements and distributional outcomes in which it had operated. Taking the perspective of critical social theories the paper concludes that, ultimately, the current financial crisis is the outcome of something much more systemic, namely an attempt to use neo-liberalism (or, in US terms, neo-conservatism) as a new technology of power to help transform capitalism into a rentiers’ delight. And in particular, into a system without much ‘compulsion’ on big business; i.e., one that imposes only minimal pressures on big agents to engage in competitive struggles in the real economy (while inflicting exactly the opposite fate on workers and small firms). A key component in the effectiveness of this new technology of power was its ability to transform the state into a major facilitator of the ever-increasing rent-seeking practices of oligopolistic capital. The architects of this experiment include some capitalist groups (in particular rentiers from the financial sector as well as capitalists from the ‘mature’ and most polluting industries of the preceding techno-economic paradigm), some political groups, as well as intellectual networks with their allies – including most economists and the ‘new’ left. Although rentiers did succeed in their attempt to get rid of practically all fetters on their greed, in the end the crisis materialised when ‘markets’ took their inevitable revenge on the rentiers by calling their (blatant) bluff.