[Recent health services reform in Quebec Province, Canada: on the frontier of preserving a public system]. / A recente reforma dos serviços de saúde na província do Québec, Canadá: as fronteiras da preservação de um sistema público.

This paper analyzes recent changes in the Canadian health system through a case study of Quebec. As the last Province to adopt federal principles of universal coverage, comprehensiveness, and public management, its reform, conducted in 1971, met these objectives by means of key innovations. In the 1980s and early 90s, a process of health services evaluation in this Province and in Canada as a whole launched a period of extensive changes. The relevant measures are described herein: decentralization and regional management, "clinical shift", selective reduction in the supply of services, and new mechanisms for resource allocation and social control. There is a tendency towards an environment of public competition, but the approach that was adopted for regulation does not correspond to the main models from central countries. Within a scenario of budget constraints, technocratically-defined measures allowed for the settlement of benefits, preserving the system's main guidelines. This evidence is one of the main contributions of comparative analysis to health system reform in peripheral countries. The study identifies the relationships between these measures and a worldwide trend towards cost control and macroeconomic adjustment policies, discussing the relevant implications for health services.

[Challenges for developing a comparative analytical model for health services]. / Desafios na construção de um modelo para naálise comparada da organização de serviços de saúde.

This paper presents different models that describe health determinants, services, and systems. It highlights the important model developed by Contandriopoulos, proposing a separation between the health status and health care circuits. The article is intended as a contribution to the field of comparative analysis with a new theoretical, methodological, and evaluative approach. Problems were identified in the development of a new model. Decentralization and access are introduced as categories, suggesting that they may take part in such new model.

[Public figures on trial: an assessment of the use of the "jury court" technique for city officials in Santa Catarina, Brazil]. / O homem público em julgamento: avaliação da aplicação da téchnica "tribunal do júri" para dirigentes municipais em Santa Catarina.

This study describes the 'Law Court' technique as applied to City Health Departments in the State of Santa Catarina, in dealing with the issue of obligations on the part of public officials. The project was the first part of a training course for public administrators held in 1997. The article presents the technique's components and results. Some 98% of the 156 participants had a positive opinion of the training course, considering it dynamic/participatory (31%), educational/stimulating reflection (27%), and realistic (24%). The technique fostered the discussion of the main subjects pertaining to the country's Unified Health System (SUS). Although all five juries acquitted the defendants, the issue of ethics was reported by 58% of the participants as the main prerequisite for a public administrator.

[The organization of health services: the comparison as contribution]. / Organização dos serviços de saúde: a comparação como contribuição.

This article discusses about a recent procedure in health care studies, the comparison as a methodology of analysis. The different analytical currents refer to a particular method of understanding health-disease process. They are: functionalism, the historical-materialism and the new currents. Their phylosophical and sociological basis, concepts, analysis instruments and purposes are showed here by a review of the principal works from representative authors as Navarro, Terris, Roemer, Fry, Illich, Capra and others. The paper suggests that comparative analysis can take two directions: the first is a operational approach for analysing the concrete situations of health's service organization, the second, a more conceptual one, aimed at identifying critical questions and international tendencies in health's systems. The recent discussion search for the overcoming of these dichotomies toward the progress of the production of knowledge and its effects in health's services organization.